| Entity Name: | AFFIRM DIRECT PRIMARY CARE P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 12 Jan 2022 (3 years ago) |
| Document Number: | P22000004315 |
| FEI/EIN Number | 87-4693335 |
| Address: | 6871 Belfort Oaks Place Suite 300, JACKSONVILLE, FL, 32216, US |
| Mail Address: | 6871 Belfort Oaks Place Suite 300, JACKSONVILLE, FL, 32216, US |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629811930 | 2024-06-14 | 2024-06-14 | 6871 BELFORT OAKS PL STE 300, JACKSONVILLE, FL, 322166242, US | 6871 BELFORT OAKS PL STE 300, JACKSONVILLE, FL, 322166242, US | |||||||||||||
|
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| Phone | +1 904-893-1990 |
Authorized person
| Name | DR. JOHNIQUE BENNETT |
| Role | DIRECTOR |
| Phone | 9048391990 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BENNETT JOHNIQUE CMD | Agent | 6871 Belfort Oaks Place Suite 300, JACKSONVILLE, FL, 32216 |
| Name | Role | Address |
|---|---|---|
| BENNETT JOHNIQUE CMD | Director | 6125 CLEARSKY DRIVE, JACKSONVILLE, FL, 32258 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-07 | 6871 Belfort Oaks Place Suite 300, JACKSONVILLE, FL 32216 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-26 | 6871 Belfort Oaks Place Suite 300, JACKSONVILLE, FL 32216 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-17 | 6871 Belfort Oaks Place Suite 300, JACKSONVILLE, FL 32216 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-01-29 |
| Domestic Profit | 2022-01-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
