| Entity Name: | PEDIATRIC EPILEPSY & NEUROLOGY SPECIALISTS, CORP. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 27 Mar 1998 (27 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 05 May 2014 (11 years ago) |
| Document Number: | P98000028573 |
| FEI/EIN Number | 593501126 |
| Address: | 508 S .HABANA AVENUE, SUITE 340, TAMPA, FL, 33609 |
| Mail Address: | 508 S. HABANA AVENUE, SUITE 340, TAMPA, FL, 33609 |
| ZIP code: | 33609 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689765737 | 2006-09-27 | 2020-08-22 | 508 S HABANA AVE, SUITE 340, TAMPA, FL, 336094181, US | 508 S HABANA AVE, SUITE 340, TAMPA, FL, 336094181, US | |||||||||||||||||||||
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| Phone | +1 813-873-7367 |
| Fax | 8138759722 |
Authorized person
| Name | DR. JOSE ANDRES FERREIRA |
| Role | PRESIDENT |
| Phone | 8138737367 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 25130B |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FERREIRA FELICIA A | Agent | 508 S. HABANA AVE., TAMPA, FL, 33609 |
| Name | Role | Address |
|---|---|---|
| FERREIRA JOSE A | Chief Executive Officer | 508 S. HABANA AVENUE, TAMPA, FL, 33609 |
| Name | Role | Address |
|---|---|---|
| FERREIRA FELICIA AMBA MHC | Chief Financial Officer | 508 S. HABANA AVENUE, TAMPA, FL, 33609 |
| Name | Role | Address |
|---|---|---|
| FERREIRA CARMEN I | Chief Operating Officer | 508 S. HABANA AVENUE, TAMPA, FL, 33609 |
| Name | Role | Address |
|---|---|---|
| Jayakody Himali R | Officer | 508 S. HABANA AVENUE, TAMPA, FL, 33609 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 2014-05-05 | PEDIATRIC EPILEPSY & NEUROLOGY SPECIALISTS, CORP. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-25 | 508 S. HABANA AVE., SUITE 340, TAMPA, FL 33609 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-04-25 | FERREIRA, FELICIA A | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-07-29 | 508 S .HABANA AVENUE, SUITE 340, TAMPA, FL 33609 | No data |
| CHANGE OF MAILING ADDRESS | 2005-07-29 | 508 S .HABANA AVENUE, SUITE 340, TAMPA, FL 33609 | No data |
| NAME CHANGE AMENDMENT | 2005-06-01 | PEDIATRIC EPILEPSY & NEUROLOGY SPECIALISTS, P.A. | No data |
| REINSTATEMENT | 2000-02-07 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1999-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-02-24 |
| ANNUAL REPORT | 2022-03-29 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-01-02 |
| ANNUAL REPORT | 2019-01-09 |
| ANNUAL REPORT | 2018-03-27 |
| ANNUAL REPORT | 2017-07-05 |
| ANNUAL REPORT | 2016-04-20 |
| ANNUAL REPORT | 2015-04-29 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
