| Entity Name: | EILEEN F. FARWICK, D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 28 Aug 1996 (28 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | P96000072631 |
| FEI/EIN Number | 59-3399780 |
| Address: | 10000 WEST COLONIAL DRIVE, 386, OCOEE, FL 34761 |
| Mail Address: | 10000 WEST COLONIAL DRIVE, 386, OCOEE, FL 34761 |
| ZIP code: | 34761 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073583761 | 2006-01-25 | 2010-05-13 | 10000 W COLONIAL DR, STE 386, OCOEE, FL, 347613498, US | 10000 W COLONIAL DR, SUITE 386, OCOEE, FL, 347613498, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 407-296-1990 |
| Fax | 4072961992 |
Authorized person
| Name | DR. EILEEN F FARWICK |
| Role | PRESIDENT |
| Phone | 4072961990 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| License Number | OS0005926 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 363LW0102X - Women's Health Nurse Practitioner |
| License Number | ARNP 9297245 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS- GROUP# |
| Number | 45231 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BLOOM, GWEN D, ESQ | Agent | 1180 SPRING CENTRE, 310, ALTAMONTE SPRINGS, FL 32714 |
| Name | Role | Address |
|---|---|---|
| FARWICK, EILEEN F | President | 10000 W .COLONIAL DR STE 386, OCOEE, FL 34761 |
| Name | Role | Address |
|---|---|---|
| FARWICK, EILEEN F | Secretary | 10000 W .COLONIAL DR STE 386, OCOEE, FL 34761 |
| Name | Role | Address |
|---|---|---|
| FARWICK, EILEEN F | Treasurer | 10000 W .COLONIAL DR STE 386, OCOEE, FL 34761 |
| Name | Role | Address |
|---|---|---|
| FARWICK, EILEEN F | Director | 10000 W .COLONIAL DR STE 386, OCOEE, FL 34761 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-01-26 | 1180 SPRING CENTRE, 310, ALTAMONTE SPRINGS, FL 32714 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2003-06-16 | 10000 WEST COLONIAL DRIVE, 386, OCOEE, FL 34761 | No data |
| CHANGE OF MAILING ADDRESS | 2002-02-19 | 10000 WEST COLONIAL DRIVE, 386, OCOEE, FL 34761 | No data |
| REGISTERED AGENT NAME CHANGED | 1999-04-29 | BLOOM, GWEN D, ESQ | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-03-28 |
| ANNUAL REPORT | 2010-02-22 |
| ANNUAL REPORT | 2009-04-17 |
| ANNUAL REPORT | 2008-04-25 |
| ANNUAL REPORT | 2007-01-26 |
| ANNUAL REPORT | 2006-04-24 |
| ANNUAL REPORT | 2005-01-17 |
| ANNUAL REPORT | 2004-02-11 |
| ANNUAL REPORT | 2003-06-16 |
| ANNUAL REPORT | 2002-02-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
