| Entity Name: | CARMEN CORNIDE, PSY.D, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Mar 1998 (27 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 14 Oct 2009 (15 years ago) |
| Document Number: | P98000029127 |
| FEI/EIN Number | 65-0835985 |
| Address: | 1601 N. PALM AVE, STE 208, PEMBROKE PINES, FL, 33026, US |
| Mail Address: | 1601 N. PALM AVE, STE 208, PEMBROKE PINES, FL, 33026, US |
| ZIP code: | 33026 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952784225 | 2015-07-06 | 2015-07-07 | 1601 N PALM AVE, SUITE 300, PEMBROKE PINES, FL, 330263200, US | 1601 N PALM AVE, SUITE 300, PEMBROKE PINES, FL, 330263200, US | |||||||||||||||||||||||||
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| Phone | +1 954-443-0018 |
| Fax | 9542366331 |
Authorized person
| Name | DR. CARMEN CORNIDE |
| Role | PRESIDENT |
| Phone | 9544430018 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY5595 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PROVIDER NUMBER |
| Number | 54131 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CORNIDE CARMEN | Agent | 3171 NW 126th Terrace, Sunrise, FL, 33323 |
| Name | Role | Address |
|---|---|---|
| CORNIDE CARMEN DR. | Director | 1601 N. PALM AVE, PEMBROKE PINES, FL, 33026 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-19 | 1601 N. PALM AVE, STE 208, PEMBROKE PINES, FL 33026 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-19 | 1601 N. PALM AVE, STE 208, PEMBROKE PINES, FL 33026 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-04-19 | CORNIDE, CARMEN | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-19 | 3171 NW 126th Terrace, Sunrise, FL 33323 | No data |
| CANCEL ADM DISS/REV | 2009-10-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-02-15 |
| ANNUAL REPORT | 2022-03-02 |
| ANNUAL REPORT | 2021-04-11 |
| ANNUAL REPORT | 2020-01-23 |
| ANNUAL REPORT | 2019-03-28 |
| ANNUAL REPORT | 2018-03-07 |
| ANNUAL REPORT | 2017-02-28 |
| ANNUAL REPORT | 2016-04-14 |
| ANNUAL REPORT | 2015-03-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
