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LAKE PEDIATRICS, P.A. - Florida Company Profile

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Company Details

Entity Name: LAKE PEDIATRICS, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 02 Jan 1996 (30 years ago)
Last Event: AMENDMENT
Event Date Filed: 20 Sep 2021 (4 years ago)
Document Number: P96000000209
FEI/EIN Number 593351823
Address: 18515 HWY 441, MT. DORA, FL, 32757, US
Mail Address: P.O. BOX 1206, TAVARES, FL, 32778, US
ZIP code: 32757
City: Mount Dora
County: Lake
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Johnson Charles D Agent Bowen & Schroth, P.A., LEESBURG, FL, 34748
WALLS ANNA N Director 488 NORTH HWY 19 A SUITE 200, MT. DORA, FL, 32747
WALLS ANNA N President 488 NORTH HWY 19 A SUITE 200, MT. DORA, FL, 32747
WALLS ANNA N Secretary 488 NORTH HWY 19 A SUITE 200, MT. DORA, FL, 32747
NETTLES DONNA L Vice President 488 NORTH HWY 19 A SUITE 200, MT DORA, FL, 32757
NETTLES DONNA L Treasurer 488 NORTH HWY 19 A SUITE 200, MT DORA, FL, 32757

Commercial and government entity program

CAGE number:
91R03
Status:
Active
Type:
Non-Manufacturer
CAGE Update Date:
2022-07-08
CAGE Expiration:
2026-06-10
SAM Expiration:
2022-07-08

Contact Information

POC:
LEIGH BORESKE
Corporate URL:
lakepediatrics.org

National Provider Identifier

NPI Number:
1518631811
Certification Date:
2021-07-07

Authorized Person:

Name:
DONNA LYNN NETTLES
Role:
BILLING MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
208000000X - Pediatrics Physician
Is Primary:
Yes

Contacts:

Fax:
3525898495

Events

Event Type Filed Date Value Description
AMENDMENT 2025-05-12 - -
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 - -

Documents

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

USAspending Awards / Financial Assistance

Date:
2021-07-21
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
RURAL HEALTH CLINIC VACCINE CONFIDENCE PROGRAM
Obligated Amount:
0.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2020-04-15
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
310580.00
Total Face Value Of Loan:
310580.00

Paycheck Protection Program

Jobs Reported:
27
Initial Approval Amount:
$310,580
Date Approved:
2021-03-13
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$310,580
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$313,056.13
Servicing Lender:
Bank of America, National Association
Use of Proceeds:
Payroll: $310,578
Utilities: $1
Jobs Reported:
24
Initial Approval Amount:
$310,580
Date Approved:
2020-04-15
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$310,580
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$314,877.07
Servicing Lender:
Bank of America, National Association
Use of Proceeds:
Payroll: $310,580

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Date of last update: 03 Aug 2025

Sources: Florida Department of State