| Entity Name: | LISA M. JUDGE, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 Sep 1998 (26 years ago) |
| Document Number: | P98000079923 |
| FEI/EIN Number | 593531729 |
| Address: | 552 TWIN CITIES BLVD. SUITE C, NICEVILLE, FL, 32578 |
| Mail Address: | 552 TWIN CITIES BLVD. SUITE C, NICEVILLE, FL, 32578 |
| ZIP code: | 32578 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124220009 | 2007-06-04 | 2009-06-23 | 552 TWIN CITIES BLVD, SUITE C, NICEVILLE, FL, 325781055, US | 552 TWIN CITIES BLVD, SUITE C, NICEVILLE, FL, 325781055, US | |||||||||||||||||||||
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| Phone | +1 850-729-1414 |
| Fax | 8507298700 |
Authorized person
| Name | LYNN ROUTHIER |
| Role | PRACTICE MANAGER |
| Phone | 8507291414 |
Taxonomy
| Taxonomy Code | 207VG0400X - Gynecology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RR MEDICARE GROUP PTAN |
| Number | DN7294 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FLEET H BART | Agent | FLEET, SPENCER, MARTIN & KILPATRICK, PA, SHALIMAR, FL, 325790000 |
| Name | Role | Address |
|---|---|---|
| JUDGE LISA M | Director | 552 TWIN CITIES BLVD STE C, NICEVILLE, FL, 32578 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2009-04-17 | 552 TWIN CITIES BLVD. SUITE C, NICEVILLE, FL 32578 | No data |
| CHANGE OF MAILING ADDRESS | 2009-04-17 | 552 TWIN CITIES BLVD. SUITE C, NICEVILLE, FL 32578 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2003-09-18 | FLEET, SPENCER, MARTIN & KILPATRICK, PA, 1104 EGLIN PARKWAY, SHALIMAR, FL 32579-0000 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-18 |
| ANNUAL REPORT | 2023-04-18 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-02-06 |
| ANNUAL REPORT | 2020-01-25 |
| ANNUAL REPORT | 2019-05-22 |
| ANNUAL REPORT | 2018-01-21 |
| ANNUAL REPORT | 2017-02-26 |
| ANNUAL REPORT | 2016-04-05 |
| ANNUAL REPORT | 2015-01-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
