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  5. BEVERLY ENCARNACION, M.D., P.A.

BEVERLY ENCARNACION, M.D., P.A.

Company Details

Entity Name: BEVERLY ENCARNACION, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 31 Aug 1998 (26 years ago)
Date of dissolution: 28 Mar 2022 (3 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 28 Mar 2022 (3 years ago)
Document Number: P98000076755
FEI/EIN Number 593538815
Address: 2128 MAIN STREET, DUNEDIN, FL, 34698
Mail Address: 2128 MAIN STREET, DUNEDIN, FL, 34698
ZIP code: 34698
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1306036777 2007-07-31 2017-06-27 2128 MAIN ST, DUNEDIN, FL, 346985604, US 2128 MAIN ST, DUNEDIN, FL, 346985604, US

Contacts
Phone +1 727-736-7733
Fax 7277367740

Authorized person
Name BEVERLY ENCARNACION
Role OWNER/PRESIDENT
Phone 7277367733

Taxonomy
Taxonomy Code 261QP2300X - Primary Care Clinic/Center
License Number ME007280
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BEVERLY ENCARNACION M D P A 401(K) PROFIT SHARING PLAN & TRUST 2020 593538815 2021-12-03 BEVERLY ENCARNACION M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7273665290
Plan sponsor’s address 8802 RUSTIC TRAIL CT, TAMPA, FL, 336355604

Signature of
Role Plan administrator
Date 2021-12-03
Name of individual signing ELPIDIO LOLENG
Valid signature Filed with authorized/valid electronic signature
BEVERLY ENCARNACION M D P A 401(K) PROFIT SHARING PLAN & TRUST 2020 593538815 2021-04-27 BEVERLY ENCARNACION M D P A 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277367733
Plan sponsor’s address 2128 MAIN ST, DUNEDIN, FL, 346985604

Signature of
Role Plan administrator
Date 2021-04-27
Name of individual signing ELPIDIO LOLENG
Valid signature Filed with authorized/valid electronic signature
BEVERLY ENCARNACION M D P A 401(K) PROFIT SHARING PLAN & TRUST 2019 593538815 2020-06-24 BEVERLY ENCARNACION M D P A 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277367733
Plan sponsor’s address 2128 MAIN ST, DUNEDIN, FL, 346985604

Signature of
Role Plan administrator
Date 2020-06-24
Name of individual signing ELPIDIO LOLENG
Valid signature Filed with authorized/valid electronic signature
BEVERLY ENCARNACION M D P A 401 K PROFIT SHARING PLAN TRUST 2018 593538815 2019-06-25 BEVERLY ENCARNACION M D P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277367733
Plan sponsor’s address 2128 MAIN ST, DUNEDIN, FL, 346985604

Signature of
Role Plan administrator
Date 2019-06-25
Name of individual signing ELPIDIO LOLENG
Valid signature Filed with authorized/valid electronic signature
BEVERLY ENCARNACION M D P A 401 K PROFIT SHARING PLAN TRUST 2017 593538815 2018-05-25 BEVERLY ENCARNACION M D P A 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277367733
Plan sponsor’s address 2128 MAIN ST, DUNEDIN, FL, 346985604

Signature of
Role Plan administrator
Date 2018-05-25
Name of individual signing ELPIDIO LOLENG
Valid signature Filed with authorized/valid electronic signature
BEVERLY ENCARNACION M D P A 401 K PROFIT SHARING PLAN TRUST 2016 593538815 2017-06-22 BEVERLY ENCARNACION M D P A 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277367733
Plan sponsor’s address 2128 MAIN ST, DUNEDIN, FL, 346985604

Signature of
Role Plan administrator
Date 2017-06-22
Name of individual signing ELPIDIO LOLENG
Valid signature Filed with authorized/valid electronic signature
BEVERLY ENCARNACION M D P A 401 K PROFIT SHARING PLAN TRUST 2015 593538815 2016-06-24 BEVERLY ENCARNACION M D P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277367733
Plan sponsor’s address 2128 MAIN ST, DUNEDIN, FL, 346985604

Signature of
Role Plan administrator
Date 2016-06-24
Name of individual signing ELPIDIO LOLENG
Valid signature Filed with authorized/valid electronic signature
BEVERLY ENCARNACION M D P A 401 K PROFIT SHARING PLAN TRUST 2014 593538815 2015-07-06 BEVERLY ENCARNACION M D P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277367733
Plan sponsor’s address 2128 MAIN ST, DUNEDIN, FL, 346985604

Signature of
Role Plan administrator
Date 2015-07-06
Name of individual signing ELPIDIO LOLENG
Valid signature Filed with authorized/valid electronic signature
BEVERLY ENCARNACION M D P A 401 K PROFIT SHARING PLAN TRUST 2013 593538815 2014-05-21 BEVERLY ENCARNACION M D P A 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277367733
Plan sponsor’s address 2128 MAIN ST, DUNEDIN, FL, 346985604

Signature of
Role Plan administrator
Date 2014-05-21
Name of individual signing ELPIDIO LOLENG
Valid signature Filed with authorized/valid electronic signature
BEVERLY ENCARNACION M D P A 401 K PROFIT SHARING PLAN TRUST 2012 593538815 2013-07-12 BEVERLY ENCARNACION M D P A 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 7277367733
Plan sponsor’s address 2128 MAIN ST, DUNEDIN, FL, 346985604

Signature of
Role Plan administrator
Date 2013-07-12
Name of individual signing BEVERLY ENCARNACION M D P A
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
LOLENG ELPIDIO M Agent 2128 MAIN STREET, DUNEDIN, FL, 34698

President

Name Role Address
ENCARNACION BEVERLY R President 2128 MAIN STREET, DUNEDIN, FL, 34698

Vice President

Name Role Address
LOLENG ELPIDIO M Vice President 2128 MAIN STREET, DUNEDIN, FL, 34698

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2022-03-28 No data No data
REGISTERED AGENT NAME CHANGED 2008-03-13 LOLENG, ELPIDIO M No data
CHANGE OF PRINCIPAL ADDRESS 2003-08-05 2128 MAIN STREET, DUNEDIN, FL 34698 No data
CHANGE OF MAILING ADDRESS 2003-08-05 2128 MAIN STREET, DUNEDIN, FL 34698 No data
REGISTERED AGENT ADDRESS CHANGED 2003-08-05 2128 MAIN STREET, DUNEDIN, FL 34698 No data
AMENDMENT AND NAME CHANGE 1998-10-19 BEVERLY ENCARNACION, M.D., P.A. No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2022-03-28
ANNUAL REPORT 2022-02-11
ANNUAL REPORT 2021-01-30
ANNUAL REPORT 2020-06-05
ANNUAL REPORT 2019-01-26
ANNUAL REPORT 2018-04-09
ANNUAL REPORT 2017-03-14
ANNUAL REPORT 2016-03-11
ANNUAL REPORT 2015-04-23
ANNUAL REPORT 2014-04-21

Related by officers

LOLENG ELPIDIO M

CAMILLIAN PRIMARY CARE, LLC

Related by address

2128 MAIN STREET, DUNEDIN, FL, 34698

CLEARWATER ALPHA WEIGHT LOSS CENTER, INC. ABSOLUTE VERTICAL BLINDS MANUFACTURING, INC.

2128 MAIN STREET, DUNEDIN, FL, 34698

CLEARWATER ALPHA WEIGHT LOSS CENTER, INC. ABSOLUTE VERTICAL BLINDS MANUFACTURING, INC.

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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