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  5. DEBRA TODD BLACK, D.O., P.A.

DEBRA TODD BLACK, D.O., P.A. - Florida Company Profile

Company Details

Entity Name: DEBRA TODD BLACK, D.O., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit

DEBRA TODD BLACK, D.O., P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act.
Status: Inactive

The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders.

Date Filed: 08 Jul 1999 (26 years ago)
Date of dissolution: 25 Sep 2015 (10 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 25 Sep 2015 (10 years ago)
Document Number: P99000061174
FEI/EIN Number 650932857

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 13440 PARKER COMMONS BLVD, SUITE 101, FORT MYERS, FL, 33912
Mail Address: 13440 PARKER COMMONS BLVD, SUITE 101, FORT MYERS, FL, 33912
ZIP code: 33912
County: Lee
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1083919500 2011-01-13 2011-01-13 13440 PARKER COMMONS BLVD, SUITE 101, FORT MYERS, FL, 339121816, US 13440 PARKER COMMONS BLVD, SUITE 101, FORT MYERS, FL, 339121816, US

Contacts
Phone +1 239-432-9383
Fax 2394329392

Authorized person
Name MRS. RENEE JEAN RICHARDS
Role OFFICE MANAGER
Phone 2394329383

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number OS5735
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DEBRA TODD BLACK, D.O., P.A. PROFIT SHARING PLAN 2014 650932857 2015-02-10 DEBRA TODD BLACK, D.O., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2394329383
Plan sponsor’s address 13440 PARKER COMMONS BLVD., STE 101, FORT MYERS, FL, 339121815
DEBRA TODD BLACK, D.O., P.A. PROFIT SHARING PLAN 2013 650932857 2014-03-28 DEBRA TODD BLACK, D.O., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2394329383
Plan sponsor’s address 13440 PARKER COMMONS BLVD., STE 101, FORT MYERS, FL, 339121815
DEBRA TODD BLACK, D.O., P.A. PROFIT SHARING PLAN 2012 650932857 2013-04-10 DEBRA TODD BLACK, D.O., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2394329383
Plan sponsor’s address 13440 PARKER COMMONS BLVD., STE 101, FORT MYERS, FL, 339121815

Signature of
Role Plan administrator
Date 2013-04-10
Name of individual signing TATIANA POMBO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-04-10
Name of individual signing TATIANA POMBO
Valid signature Filed with authorized/valid electronic signature
DEBRA TODD BLACK, D.O., P.A. PROFIT SHARING PLAN 2011 650932857 2012-07-20 DEBRA TODD BLACK, D.O., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2394329383
Plan sponsor’s address 13440 PARKER COMMONS BLVD., STE 101, FORT MYERS, FL, 339121815

Plan administrator’s name and address
Administrator’s EIN 650932857
Plan administrator’s name DEBRA TODD BLACK, D.O., P.A.
Plan administrator’s address 13440 PARKER COMMONS BLVD., STE 101, FORT MYERS, FL, 339121815
Administrator’s telephone number 2394329383

Signature of
Role Plan administrator
Date 2012-07-20
Name of individual signing TATIANA POMBO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-20
Name of individual signing TATIANA POMBO
Valid signature Filed with authorized/valid electronic signature
DEBRA TODD BLACK, D.O., P.A. PROFIT SHARING PLAN 2010 650932857 2011-07-11 DEBRA TODD BLACK, D.O., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2394329383
Plan sponsor’s address 13440 PARKER COMMONS BLVD., STE 101, FORT MYERS, FL, 339121815

Plan administrator’s name and address
Administrator’s EIN 650932857
Plan administrator’s name DEBRA TODD BLACK, D.O., P.A.
Plan administrator’s address 13440 PARKER COMMONS BLVD., STE 101, FORT MYERS, FL, 339121815
Administrator’s telephone number 2394329383

Signature of
Role Plan administrator
Date 2011-07-11
Name of individual signing TATIANA CHAVEZ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-11
Name of individual signing TATIANA CHAVEZ
Valid signature Filed with authorized/valid electronic signature
DEBRA TODD BLACK, D.O., P.A. PROFIT SHARING PLAN 2009 650932857 2010-07-28 DEBRA TODD BLACK, D.O., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2394329383
Plan sponsor’s address 16339 SOUTH TAMIAMI TRAIL, FORT MYERS, FL, 33908

Plan administrator’s name and address
Administrator’s EIN 650932857
Plan administrator’s name DEBRA TODD BLACK, D.O., P.A.
Plan administrator’s address 16339 SOUTH TAMIAMI TRAIL, FORT MYERS, FL, 33908
Administrator’s telephone number 2394329383

Signature of
Role Plan administrator
Date 2010-07-28
Name of individual signing JULIE BURGESS
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
BLACK DEBRA TODD D President 13440 PARKER COMMONS BLVD, SUITE 101, FORT MYERS, FL, 33912
BLACK DEBRA TODD D Agent 13440 PARKER COMMONS BLVD, FORT MYERS, FL, 33912

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2015-09-25 - -
CHANGE OF PRINCIPAL ADDRESS 2011-04-08 13440 PARKER COMMONS BLVD, SUITE 101, FORT MYERS, FL 33912 -
CHANGE OF MAILING ADDRESS 2011-04-08 13440 PARKER COMMONS BLVD, SUITE 101, FORT MYERS, FL 33912 -
REGISTERED AGENT ADDRESS CHANGED 2011-04-08 13440 PARKER COMMONS BLVD, SUITE 101, FORT MYERS, FL 33912 -

Documents

Name Date
ANNUAL REPORT 2014-04-30
ANNUAL REPORT 2013-05-01
ANNUAL REPORT 2012-04-24
ANNUAL REPORT 2011-04-08
ANNUAL REPORT 2010-04-15
ANNUAL REPORT 2009-04-24
ANNUAL REPORT 2008-04-28
ANNUAL REPORT 2007-04-25
ANNUAL REPORT 2006-04-10
ANNUAL REPORT 2005-02-07

Companies related by officers

No other companies in our directory share the same officers as DEBRA TODD BLACK, D.O., P.A.

Companies related by address

No other companies in our directory share the same address as DEBRA TODD BLACK, D.O., P.A.

Date of last update: 02 Apr 2025

Sources: Florida Department of State

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