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EMERALD COAST DERMATOLOGY AND SKIN SURGERY CENTER, P.A. - Florida Company Profile

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Company Details

Entity Name: EMERALD COAST DERMATOLOGY AND SKIN SURGERY CENTER, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 27 Sep 1999 (26 years ago)
Document Number: P99000085987
FEI/EIN Number 593604023
Address: 350 WEST REDSTONE AVE., CRESTVIEW, FL, 32536
Mail Address: 350 WEST REDSTONE AVE., CRESTVIEW, FL, 32536
ZIP code: 32536
City: Crestview
County: Okaloosa
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
TRAPP CHARLES FDr. Director 350 WEST REDSTONE AVE., CRESTVIEW, FL, 32536
TRAPP CHARLES F Agent 350 WEST REDSTONE AVE., CRESTVIEW, FL, 32536

Unique Entity ID

Unique Entity ID:
HEEST5MCVC93
UEI Expiration Date:
2026-04-15

Business Information

Doing Business As:
EMERALD COAST DERMATOLOGY
Division Name:
EMERALD COAST DERMATOLOGY AND SKIN SURGERY CENTER PA
Activation Date:
2025-04-17
Initial Registration Date:
2024-06-14

National Provider Identifier

NPI Number:
1386639912
Certification Date:
2025-03-14

Authorized Person:

Name:
JILLIAN OWENS
Role:
CREDENTIALING AND CONTRACTING
Phone:

Taxonomy:

Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Fax:
8506826652

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G08214700031 EMERALD COAST DERMATOLOGY EXPIRED 2008-08-01 2013-12-31 - 350 WEST REDSTONE AVENUE, CRESTVIEW, FL, 32536

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2023-03-16 TRAPP, CHARLES F. -
CHANGE OF PRINCIPAL ADDRESS 2003-02-21 350 WEST REDSTONE AVE., CRESTVIEW, FL 32536 -
CHANGE OF MAILING ADDRESS 2003-02-21 350 WEST REDSTONE AVE., CRESTVIEW, FL 32536 -
REGISTERED AGENT ADDRESS CHANGED 2003-02-21 350 WEST REDSTONE AVE., CRESTVIEW, FL 32536 -

Documents

Name Date
ANNUAL REPORT 2024-04-01
ANNUAL REPORT 2023-03-16
ANNUAL REPORT 2022-03-14
ANNUAL REPORT 2021-04-11
ANNUAL REPORT 2020-04-25
ANNUAL REPORT 2019-04-29
ANNUAL REPORT 2018-04-16
ANNUAL REPORT 2017-04-24
ANNUAL REPORT 2016-03-30
ANNUAL REPORT 2015-04-29

Paycheck Protection Program

Jobs Reported:
18
Initial Approval Amount:
$206,249.77
Date Approved:
2021-01-27
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$206,249.77
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$207,831.02
Servicing Lender:
CCB Community Bank
Use of Proceeds:
Payroll: $206,247.77
Utilities: $1

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Date of last update: 03 Aug 2025

Sources: Florida Department of State