| Entity Name: | MARY JOSEFYK, DNP, APRN, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 01 Sep 2023 (a year ago) |
| Document Number: | P23000063886 |
| FEI/EIN Number | 93-3292561 |
| Address: | 13 NORTH MAIN AVENUE, LAKE PLACID, FL, 33852, US |
| Mail Address: | P.O. Box 718, LAKE PLACID, FL, 33862, US |
| ZIP code: | 33852 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942089453 | 2023-09-25 | 2023-10-20 | PO BOX 718, LAKE PLACID, FL, 338620718, US | 13 N MAIN AVE, LAKE PLACID, FL, 338522603, US | |||||||||||||||||||
|
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| Phone | +1 863-659-1079 |
| Fax | 8636591317 |
Authorized person
| Name | MARY E JOSEFYK |
| Role | PRESIDENT |
| Phone | 8638406095 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| JOSEFYK MARY E | Agent | 220 ANNA MARIA WAY NE, LAKE PLACID, FL, 33852 |
| Name | Role | Address |
|---|---|---|
| JOSEFYK MARY | President | 220 ANNA MARIA WAY NE, LAKE PLACID, FL, 33852 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000107341 | MAIN AVENUE MEDICAL | ACTIVE | 2023-09-07 | 2028-12-31 | No data | 13 NORTH MAIN AVENUE, LAKE PLACID, FL, 33852 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-02-12 | 13 NORTH MAIN AVENUE, LAKE PLACID, FL 33852 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| Domestic Profit | 2023-09-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
