| Entity Name: | FLAGLER FAMILY MEDICINE, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Feb 1996 (29 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 27 Oct 2015 (9 years ago) |
| Document Number: | P96000011755 |
| FEI/EIN Number | 593423198 |
| Address: | 130 HEALTH PARK BLVD., ST AUGUSTINE, FL, 32086, US |
| Mail Address: | 130 HEALTH PARK BLVD., ST AUGUSTINE, FL, 32086, US |
| ZIP code: | 32086 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538646757 | 2018-07-20 | 2018-07-20 | 130 HEALTH PARK BLVD, ST AUGUSTINE, FL, 320865776, US | 52 TUSCAN WAY STE 205, ST AUGUSTINE, FL, 320921850, US | |||||||||||||||||||
|
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| Phone | +1 904-826-3469 |
Authorized person
| Name | WARREN WHITLOCK |
| Role | AUTHORIZED OFFICIAL / PARTNER |
| Phone | 9048263469 |
Taxonomy
| Taxonomy Code | 213E00000X - Podiatrist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 252488100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Look Michael | Agent | 130 HEALTH PARK BLVD, ST AUGUSTINE, FL, 32086 |
| Name | Role | Address |
|---|---|---|
| CLONCH LINDA S | Officer | 130 HEALTH PARK BLVD, ST AUGUSTINE, FL, 32086 |
| Jguenti Milena | Officer | 130 HEALTH PARK BLVD., ST AUGUSTINE, FL, 32086 |
| Name | Role | Address |
|---|---|---|
| ZUB CHRISTOPHER J | Vice President | 130 HEALTH PARK BLVD., ST. AUGUSTINE, FL, 32086 |
| Name | Role | Address |
|---|---|---|
| LOOK MICHAEL J | President | 130 HEALTH PARK BLVD., ST AUGUSTINE, FL, 32086 |
| Name | Role | Address |
|---|---|---|
| SANCHEZ CARLOS M | Secretary | 130 HEALTH PARK BLVD., ST AUGUSTINE, FL, 32086 |
| Name | Role | Address |
|---|---|---|
| Calain Jodie S | Treasurer | 130 HEALTH PARK BLVD., ST AUGUSTINE, FL, 32086 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000083327 | FLAGLER FAMILY MEDICINE AND WELLNESS | EXPIRED | 2014-08-13 | 2024-12-31 | No data | 130 HEALTH PARK BLVD, ST AUGUSTINE, FL, 32086 |
| G14000014281 | LIGHTHOUSE MEDICAL ASSOCIATES | EXPIRED | 2014-02-10 | 2024-12-31 | No data | 130 HEALTH PARK BLVD, SAINT AUGUSTINE, FL, 32086 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-02-01 | Look, Michael | No data |
| AMENDMENT | 2015-10-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2008-03-13 | 130 HEALTH PARK BLVD., ST AUGUSTINE, FL 32086 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1998-01-23 | 130 HEALTH PARK BLVD., ST AUGUSTINE, FL 32086 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1998-01-23 | 130 HEALTH PARK BLVD, ST AUGUSTINE, FL 32086 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-14 |
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-01-21 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-01-03 |
| ANNUAL REPORT | 2018-01-23 |
| ANNUAL REPORT | 2017-01-12 |
| ANNUAL REPORT | 2016-05-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
