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  5. ROBERT A. NORMAN, D.O., P.A.

ROBERT A. NORMAN, D.O., P.A.

Company Details

Entity Name: ROBERT A. NORMAN, D.O., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 13 Jan 1995 (30 years ago)
Document Number: P95000004103
FEI/EIN Number 650550484
Address: 10820 SHELDON RD, TAMPA, FL, 33626, US
Mail Address: 10820 SHELDON RD, TAMPA, FL, 33626, US
ZIP code: 33626
County: Hillsborough
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1558391219 2006-07-05 2024-01-30 10820 SHELDON RD, TAMPA, FL, 336265117, US 10820 SHELDON RD, TAMPA, FL, 336265117, US

Contacts
Phone +1 813-880-7546
Fax 8132495210

Authorized person
Name DR. ROBERT A. NORMAN
Role CEO
Phone 8138807546

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
License Number OS4442
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 112987500
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ROBERT NORMAN, D.O., P.A. PROFIT SHARING PLAN 2019 650550484 2020-10-13 ROBERT A. NORMAN, D.O., P.A. 63
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 8138807546
Plan sponsor’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601

Signature of
Role Plan administrator
Date 2020-10-13
Name of individual signing CAROL NORMAN
Valid signature Filed with authorized/valid electronic signature
ROBERT NORMAN, D.O., P.A. PROFIT SHARING PLAN 2018 650550484 2019-10-11 ROBERT A. NORMAN, D.O., P.A. 58
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 8138807546
Plan sponsor’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601

Signature of
Role Plan administrator
Date 2019-10-11
Name of individual signing CAROL NORMAN
Valid signature Filed with authorized/valid electronic signature
ROBERT NORMAN, D.O., P.A. PROFIT SHARING PLAN 2017 650550484 2018-10-11 ROBERT A. NORMAN, D.O., P.A. 55
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 8138807546
Plan sponsor’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601

Signature of
Role Plan administrator
Date 2018-10-11
Name of individual signing CAROL NORMAN
Valid signature Filed with authorized/valid electronic signature
ROBERT NORMAN, D.O., P.A. PROFIT SHARING PLAN 2016 650550484 2017-10-16 ROBERT A. NORMAN, D.O., P.A. 50
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 8138807546
Plan sponsor’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601

Signature of
Role Plan administrator
Date 2017-10-16
Name of individual signing CAROL NORMAN
Valid signature Filed with authorized/valid electronic signature
ROBERT NORMAN, D.O., P.A. PROFIT SHARING PLAN 2015 650550484 2016-10-12 ROBERT A. NORMAN, D.O., P.A. 51
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 8138807546
Plan sponsor’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601

Signature of
Role Plan administrator
Date 2016-10-12
Name of individual signing CAROL NORMAN
Valid signature Filed with authorized/valid electronic signature
ROBERT NORMAN, D.O., P.A. PROFIT SHARING PLAN 2014 650550484 2015-10-12 ROBERT A. NORMAN, D.O., P.A. 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 8138807546
Plan sponsor’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601

Plan administrator’s name and address
Administrator’s EIN 650550484
Plan administrator’s name ROBERT A. NORMAN, D.O., P.A.
Plan administrator’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601
Administrator’s telephone number 8138807546

Signature of
Role Plan administrator
Date 2015-10-12
Name of individual signing CAROL NORMAN
Valid signature Filed with authorized/valid electronic signature
ROBERT NORMAN, D.O., P.A. PROFIT SHARING PLAN 2013 650550484 2014-10-13 ROBERT A. NORMAN, D.O., P.A. 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 8138807546
Plan sponsor’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601

Plan administrator’s name and address
Administrator’s EIN 650550484
Plan administrator’s name ROBERT A. NORMAN, D.O., P.A.
Plan administrator’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601
Administrator’s telephone number 8138807546

Signature of
Role Plan administrator
Date 2014-10-13
Name of individual signing CAROL NORMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-13
Name of individual signing ROBERT A. NORMAN
Valid signature Filed with authorized/valid electronic signature
ROBERT NORMAN, D.O., P.A. PROFIT SHARING PLAN 2012 650550484 2013-10-11 ROBERT A. NORMAN, D.O., P.A. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 8138807546
Plan sponsor’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601

Plan administrator’s name and address
Administrator’s EIN 650550484
Plan administrator’s name ROBERT A. NORMAN, D.O., P.A.
Plan administrator’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601
Administrator’s telephone number 8138807546

Signature of
Role Plan administrator
Date 2013-10-11
Name of individual signing CAROL NORMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-11
Name of individual signing ROBERT A. NORMAN
Valid signature Filed with authorized/valid electronic signature
ROBERT NORMAN, D.O., P.A. PROFIT SHARING PLAN 2011 650550484 2012-10-15 ROBERT A. NORMAN, D.O., P.A. 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 8138807546
Plan sponsor’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601

Plan administrator’s name and address
Administrator’s EIN 650550484
Plan administrator’s name ROBERT A. NORMAN, D.O., P.A.
Plan administrator’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601
Administrator’s telephone number 8138807546

Signature of
Role Plan administrator
Date 2012-10-15
Name of individual signing CAROL NORMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-15
Name of individual signing ROBERT A. NORMAN
Valid signature Filed with authorized/valid electronic signature
ROBERT NORMAN, D.O., P.A. PROFIT SHARING PLAN 2010 650550484 2011-10-03 ROBERT A. NORMAN, D.O., P.A. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 8138807546
Plan sponsor’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601

Plan administrator’s name and address
Administrator’s EIN 650550484
Plan administrator’s name ROBERT A. NORMAN, D.O., P.A.
Plan administrator’s address 8002 BEATTY GROVE, TAMPA, FL, 336261601
Administrator’s telephone number 8138807546

Signature of
Role Plan administrator
Date 2011-10-03
Name of individual signing CAROL NORMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-03
Name of individual signing ROBERT A. NORMAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
NORMAN ROBERT A Agent 10820 SHELDON RD, TAMPA, FL, 33626

Director

Name Role Address
NORMAN ROBERT A Director 10820 SHELDON RD, TAMPA, FL, 33626

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G16000053312 TREE OF LIFE MEDI SPA EXPIRED 2016-05-27 2021-12-31 No data 8001 BEATY GROVE DR, TAMPA, FL, 33626

Events

Event Type Filed Date Value Description
REINSTATEMENT 2014-10-06 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2014-09-26 No data No data
REINSTATEMENT 1999-10-01 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 1998-10-16 No data No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J19000235752 LAPSED 8:15-CV-1506-SDM-AEP US MIDDLE DISTRICT OF FLORIDA 2019-03-25 2024-04-03 $78,967.50 THEODORE A. SCHIFF, M.D., 1301 INTERNATIONAL PARKWAY, SUITE 120, SUNRISE, FLORIDA 33323
J05000046331 TERMINATED 522002CA004517XXCICI PINELLAS COUNTY CIRCUIT CIVIL 2005-04-05 2010-04-06 $115,853.95 COLLETTE PALMISANO, 150 SECOND AVENUE NORTH, SUITE 900, ST. PETERSBURG, FL 33701

Related by officers

NORMAN ROBERT A

NON-SURGICAL SKIN CANCER THERAPY, LLC NORMAN PROPERTIES, L.L.C. DERMATOLOGY HEALTHCARE, L.L.C.

Related by address

No related companies by address

Date of last update: 02 Jan 2025

Sources: Florida Department of State

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