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  5. JERRI L. JOHNSON, M.D., P.A.

JERRI L. JOHNSON, M.D., P.A.

Company Details

Entity Name: JERRI L. JOHNSON, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Inactive
Date Filed: 29 Mar 1993 (32 years ago)
Date of dissolution: 11 Nov 2023 (a year ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 11 Nov 2023 (a year ago)
Document Number: P93000024152
FEI/EIN Number 59-3172185
Address: 702 Gladwin Ave, Fern Park, FL 32730
Mail Address: 702 Gladwin Ave, Fern Park, FL 32730
ZIP code: 32730
County: Seminole
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1588856231 2007-08-16 2007-08-16 411 MAITLAND AVE, SUITE 1001, ALTAMONTE SPRINGS, FL, 327015448, US 411 MAITLAND AVE, SUITE 1001, ALTAMONTE SPRINGS, FL, 327015448, US

Contacts
Phone +1 407-260-2606
Fax 4072606339

Authorized person
Name AMY KEENEY
Role OFFICE MANAGER
Phone 4072602606

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number ME0049721
State FL
Is Primary Yes

Other Provider Identifiers
Issuer NPI TYPE I
Number 1588648265
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
401K/PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF JERRI L. JOHNSON, M.D., P.A. 2023 593172185 2024-04-02 JERRI L. JOHNSON, M.D., P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 4075995900
Plan sponsor’s address 702 GLADWIN AVENUE, FERN PARK, FL, 327302004
401K/PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF JERRI L. JOHNSON, M.D., P.A. 2022 593172185 2023-05-08 JERRI L. JOHNSON, M.D., P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 4075995900
Plan sponsor’s address 702 GLADWIN AVENUE, FERN PARK, FL, 327302004
401K/PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF JERRI L. JOHNSON, M.D., P.A. 2021 593172185 2022-09-09 JERRI L. JOHNSON, M.D., P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 4075995900
Plan sponsor’s address 411 MAITLAND AVENUE, SUITE 1001, ALTAMONTE SPRINGS, FL, 327015448
401K/PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF JERRI L. JOHNSON, M.D., P.A. 2020 593172185 2021-08-23 JERRI L. JOHNSON, M.D., P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 4075995900
Plan sponsor’s address 411 MAITLAND AVENUE, SUITE 1001, ALTAMONTE SPRINGS, FL, 327015448
401K/PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF JERRI L. JOHNSON, M.D., P.A. 2019 593172185 2020-09-18 JERRI L. JOHNSON, M.D., P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 4075995900
Plan sponsor’s address 411 MAITLAND AVENUE, SUITE 1001, ALTAMONTE SPRINGS, FL, 327015448
401K/PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF JERRI L. JOHNSON, M.D., P.A. 2018 593172185 2019-06-27 JERRI L. JOHNSON, M.D., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 4075995900
Plan sponsor’s address 411 MAITLAND AVENUE, SUITE 1001, ALTAMONTE SPRINGS, FL, 327015448
401K/PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF JERRI L. JOHNSON, M.D., P.A. 2017 593172185 2018-08-30 JERRI L. JOHNSON, M.D., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 4075995900
Plan sponsor’s address 411 MAITLAND AVENUE, SUITE 1001, ALTAMONTE SPRINGS, FL, 327015448
401K/PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF JERRI L. JOHNSON, M.D., P.A. 2016 593172185 2017-08-23 JERRI L. JOHNSON, M.D., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 4075995900
Plan sponsor’s address 411 MAITLAND AVENUE, SUITE 1001, ALTAMONTE SPRINGS, FL, 327015448

Signature of
Role Plan administrator
Date 2017-08-23
Name of individual signing JERRI L. JOHNSON, M.D.
Valid signature Filed with authorized/valid electronic signature
401K/PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF JERRI L. JOHNSON, M.D., P.A. 2015 593172185 2016-09-21 JERRI L. JOHNSON, M.D., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 4075995900
Plan sponsor’s address 411 MAITLAND AVENUE, SUITE 1001, ALTAMONTE SPRINGS, FL, 327015448

Signature of
Role Plan administrator
Date 2016-09-21
Name of individual signing JERRI L. JOHNSON, M.D.
Valid signature Filed with authorized/valid electronic signature
401K/PROFIT SHARING PLAN AND TRUST FOR EMPLOYEES OF JERRI L. JOHNSON, M.D., P.A. 2014 593172185 2015-06-16 JERRI L. JOHNSON, M.D., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621111
Sponsor’s telephone number 4075995900
Plan sponsor’s address 411 MAITLAND AVENUE, SUITE 1001, ALTAMONTE SPRINGS, FL, 327015448

Signature of
Role Plan administrator
Date 2015-06-16
Name of individual signing JERRI L. JOHNSON, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JOHNSON, JERRI L, MD Agent 702 Gladwin Ave, Fern Park, FL 32730

President

Name Role Address
JOHNSON, JERRI L , MD President 702 Gladwin Ave, Fern Park, FL 32730

Secretary

Name Role Address
JOHNSON, JERRI L , MD Secretary 702 Gladwin Ave, Fern Park, FL 32730

Treasurer

Name Role Address
JOHNSON, JERRI L , MD Treasurer 702 Gladwin Ave, Fern Park, FL 32730

Director

Name Role Address
JOHNSON, JERRI L , MD Director 702 Gladwin Ave, Fern Park, FL 32730

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G13000055438 ALTAMONTE DERMATOLOGY EXPIRED 2013-06-06 2018-12-31 No data 411 MAITLAND AVE, SUITE 1001, ALTAMONTE SPRINGS, FL, 32701

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2023-11-11 No data No data
CHANGE OF PRINCIPAL ADDRESS 2023-01-09 702 Gladwin Ave, Fern Park, FL 32730 No data
CHANGE OF MAILING ADDRESS 2023-01-09 702 Gladwin Ave, Fern Park, FL 32730 No data
REGISTERED AGENT ADDRESS CHANGED 2023-01-09 702 Gladwin Ave, Fern Park, FL 32730 No data
REGISTERED AGENT NAME CHANGED 2013-01-07 JOHNSON, JERRI L, MD No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2023-11-11
ANNUAL REPORT 2023-01-09
ANNUAL REPORT 2022-01-23
ANNUAL REPORT 2021-01-09
ANNUAL REPORT 2020-01-15
ANNUAL REPORT 2019-01-27
ANNUAL REPORT 2018-01-08
ANNUAL REPORT 2017-01-10
ANNUAL REPORT 2016-03-26
ANNUAL REPORT 2015-01-07

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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