| Entity Name: | JAY S. HERBST, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 03 Mar 1993 (32 years ago) |
| Document Number: | P93000015945 |
| FEI/EIN Number | 65-0384510 |
| Address: | 2866 TAMIAMI TRAIL, SUITE A, PORT CHARLOTTE, FL 33952 |
| Mail Address: | 2866 TAMIAMI TRAIL, SUITE A, PORT CHARLOTTE, FL 33952 |
| ZIP code: | 33952 |
| County: | Charlotte |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033488424 | 2011-12-14 | 2011-12-14 | 2866 TAMIAMI TRL, SUITE A, PORT CHARLOTTE, FL, 339525126, US | 2866 TAMIAMI TRL, SUITE A, PORT CHARLOTTE, FL, 339525126, US | |||||||||||||||||||
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| Phone | +1 941-764-1055 |
| Fax | 9417647984 |
Authorized person
| Name | DR. JAY STEVEN HERBST |
| Role | MEDICAL DIRECTOR |
| Phone | 9417641055 |
Taxonomy
| Taxonomy Code | 207NS0135X - Procedural Dermatology Physician |
| License Number | ME 46734 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAY S. HERBST, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST | 2017 | 650384510 | 2018-10-12 | JAY S. HERBST, M.D., P.A. | 1 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2018-10-12 |
| Name of individual signing | JAY S. HERBST, M.D. |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| herbst, jay s | Agent | 2866 TAMIAMI TRAIL, SUITE A, PORT CHARLOTTE, FL 33952 |
| Name | Role | Address |
|---|---|---|
| HERBST, JAY S | President | 2866-A TAMIAMI TRAIL, PORT CHARLOTTE, FL |
| Name | Role | Address |
|---|---|---|
| HERBST, JAY S | Secretary | 2866-A TAMIAMI TRAIL, PORT CHARLOTTE, FL |
| Name | Role | Address |
|---|---|---|
| HERBST, JAY S | Director | 2866-A TAMIAMI TRAIL, PORT CHARLOTTE, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2016-03-12 | herbst, jay s | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-12 | 2866 TAMIAMI TRAIL, SUITE A, PORT CHARLOTTE, FL 33952 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1997-01-29 | 2866 TAMIAMI TRAIL, SUITE A, PORT CHARLOTTE, FL 33952 | No data |
| CHANGE OF MAILING ADDRESS | 1997-01-29 | 2866 TAMIAMI TRAIL, SUITE A, PORT CHARLOTTE, FL 33952 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-15 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-02-23 |
| ANNUAL REPORT | 2021-03-21 |
| ANNUAL REPORT | 2020-04-23 |
| ANNUAL REPORT | 2019-01-15 |
| ANNUAL REPORT | 2018-01-04 |
| ANNUAL REPORT | 2017-01-11 |
| ANNUAL REPORT | 2016-03-12 |
| ANNUAL REPORT | 2015-02-24 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
