| Entity Name: | LAKE PEDIATRICS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
LAKE PEDIATRICS, P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 02 Jan 1996 (29 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 20 Sep 2021 (4 years ago) |
| Document Number: | P96000000209 |
| FEI/EIN Number |
593351823
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 18515 HWY 441, MT. DORA, FL, 32757, US |
| Mail Address: | P.O. BOX 1206, TAVARES, FL, 32778, US |
| ZIP code: | 32757 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518631811 | 2021-08-02 | 2021-08-02 | 4880 N HIGHWAY 19A, MOUNT DORA, FL, 327572018, US | 4880 N HIGHWAY 19A, MOUNT DORA, FL, 327572018, US | |||||||||||||||||||||
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| Phone | +1 352-589-8111 |
| Fax | 3525898495 |
Authorized person
| Name | DONNA LYNN NETTLES |
| Role | BILLING MANAGER |
| Phone | 3526384997 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 054225301 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CARLSON, M.D. E. THOMAS | President | 4880 NORTH HWY 19 A, MT. DORA, FL, 32757 |
| CARLSON, M.D. E. THOMAS | Secretary | 4880 NORTH HWY 19 A, MT. DORA, FL, 32757 |
| CARLSON GAIL A | Vice President | 4880 NORTH HWY 19 A, MT. DORA, FL, 32757 |
| CARLSON GAIL A | Treasurer | 4880 NORTH HWY 19 A, MT. DORA, FL, 32757 |
| Johnson Charles D | Agent | Bowen & Schroth, P.A., LEESBURG, FL, 34748 |
| CARLSON, M.D. E. THOMAS | Director | 4880 NORTH HWY 19 A, MT. DORA, FL, 32757 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-06-07 | Bowen & Schroth, P.A., 1330 Citizens Blvd., Suite 404, LEESBURG, FL 34748 | - |
| REGISTERED AGENT NAME CHANGED | 2023-05-01 | Johnson, Charles D | - |
| AMENDMENT | 2021-09-20 | - | - |
| REINSTATEMENT | 2014-10-02 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2007-04-26 | 18515 HWY 441, MT. DORA, FL 32757 | - |
| CHANGE OF MAILING ADDRESS | 2006-02-07 | 18515 HWY 441, MT. DORA, FL 32757 | - |
| REINSTATEMENT | 2003-11-20 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2003-09-19 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-06-07 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-05-16 |
| Amendment | 2021-09-20 |
| ANNUAL REPORT | 2021-03-09 |
| ANNUAL REPORT | 2020-05-04 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-05-01 |
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-03-11 |
Date of last update: 03 Apr 2025
Sources: Florida Department of State
