| Entity Name: | DIANA PEREZ-NUNEZ, APRN, CO |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 01 Oct 2020 (4 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | P20000078973 |
| Address: | 23109 OLD INLET BRIDGE DRIVE, BOCA RATON, FL 33433 |
| Mail Address: | 23109 OLD INLET BRIDGE DRIVE, BOCA RATON, FL 33433 |
| ZIP code: | 33433 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861091217 | 2020-10-17 | 2020-10-17 | 23109 OLD INLET BRIDGE DR, BOCA RATON, FL, 334336825, US | 7320 E FLETCHER AVE STE 108, TAMPA, FL, 336370916, US | |||||||||||||||||||||||
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| Phone | +1 561-843-0330 |
| Phone | +1 561-264-6370 |
| Fax | 5614616255 |
Authorized person
| Name | MRS. DIANA PEREZ-NUNEZ |
| Role | APRN |
| Phone | 5618430330 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 102504200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PEREZ-NUNEZ, DIANA | Agent | 23109 OLD INLET BRIDGE DRIVE, BOCA RATON, FL 33433 |
| Name | Role | Address |
|---|---|---|
| PEREZ-NUNEZ, DIANA | President | 23109 OLD INLET BRIDGE DRIVE, BOCA RATON, FL 33433 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| Name | Date |
|---|---|
| Domestic Profit | 2020-10-01 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
