| Entity Name: | JEREMY N. HARRIS, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Apr 1998 (27 years ago) |
| Document Number: | P98000032292 |
| FEI/EIN Number | 593500392 |
| Address: | 943 Cesery Blvd, Bldg G, Jacksonville, FL, 32211, US |
| Mail Address: | 943 Cesery Blvd, Bldg G, Jacksonville, FL, 32211, US |
| ZIP code: | 32211 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609334515 | 2019-03-10 | 2019-03-11 | 943 CESERY BLVD STE G, JACKSONVILLE, FL, 322115655, US | 3636 UNIVERSITY BLVD S STE B3, JACKSONVILLE, FL, 322164223, US | |||||||||||||||||||||||
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| Phone | +1 904-861-1330 |
| Phone | +1 904-448-3387 |
| Fax | 9045125235 |
Authorized person
| Name | NOORJAHAN ALI |
| Role | PHYSICIAN |
| Phone | 9048611330 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 055677700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Ali Noorjahan Dr. | Agent | 943 Cesery Blvd, Bldg G, Jacksonville, FL, 32211 |
| Name | Role | Address |
|---|---|---|
| Ali Noorjahan Dr. | President | 943 Cesery Blvd, Bldg G, Jacksonville, FL, 32211 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-21 | 943 Cesery Blvd, Bldg G, Jacksonville, FL 32211 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-21 | 943 Cesery Blvd, Bldg G, Jacksonville, FL 32211 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-21 | 943 Cesery Blvd, Bldg G, Jacksonville, FL 32211 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-02-14 | Ali, Noorjahan , Dr. | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J12000797475 | TERMINATED | 1000000303060 | DUVAL | 2012-10-24 | 2032-10-31 | $ 332.48 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-17 |
| ANNUAL REPORT | 2024-01-27 |
| ANNUAL REPORT | 2023-02-01 |
| ANNUAL REPORT | 2022-01-23 |
| ANNUAL REPORT | 2021-01-30 |
| ANNUAL REPORT | 2020-01-21 |
| ANNUAL REPORT | 2019-02-14 |
| ANNUAL REPORT | 2018-02-25 |
| ANNUAL REPORT | 2017-03-25 |
| ANNUAL REPORT | 2016-03-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
