| Entity Name: | COASTAL NEUROLOGY, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 14 Oct 1999 (25 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 23 Oct 2018 (6 years ago) |
| Document Number: | P99000091954 |
| FEI/EIN Number | 593609982 |
| Address: | 725 W Granada Blvd, Ormond Beach, FL, 32174, US |
| Mail Address: | 725 W Granada Blvd, Suite 22, Ormond Beach, FL, 32174, US |
| ZIP code: | 32174 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457358434 | 2005-07-05 | 2023-03-24 | 725 W GRANADA BLVD, SUITE 22, ORMOND BEACH, FL, 32174, US | 725 W GRANADA BLVD, SUITE 22, ORMOND BEACH, FL, 32174, US | |||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 386-788-2300 |
| Fax | 3869446622 |
Authorized person
| Name | DR. NEIL M BROWN |
| Role | CEO |
| Phone | 3867882300 |
Taxonomy
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | No |
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | OS5774 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| License Number | ME84820 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363AM0700X - Medical Physician Assistant |
| License Number | PA1823 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | INDIVIDUAL-BENEZETTE |
| Number | E60482 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Brown Jeremy | Agent | 725 W Granada Blvd, Ormond Beach, FL, 32174 |
| Name | Role | Address |
|---|---|---|
| BENEZETTE ALYN L | Director | 725 W GRANADA BLVD, ORMOND BEACH, FL, 32174 |
| BROWN NEIL M | Director | 725 W GRANADA BLVD, ORMOND BEACH, FL, 32174 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000118595 | COASTAL PAIN AND NEUROLOGY CENTERS | EXPIRED | 2019-11-12 | 2024-12-31 | No data | 725 W. GRANADA BLVD., SUITE 22, ORMOND BEACH, FL, 32174 |
| G18000123497 | COASTAL PAIN, NEUROLOGY AND NEUROSURGERY CENTERS | EXPIRED | 2018-11-19 | 2023-12-31 | No data | 725 WEST GRANADA BLVD,, SUITE 22, ORMOND BEACH, FL, 32174 |
| G18000114690 | COASTAL PAIN, NEUROLOGY AND NEUROSURGICAL CENTERS | EXPIRED | 2018-10-23 | 2023-12-31 | No data | 725 WEST GRANADA BLVD, SUITE 22, ORMOND BEACH, FL, 32177-4 |
| G13000110806 | COASTAL PAIN AND NEUROLOGY CENTERS | EXPIRED | 2013-11-12 | 2018-12-31 | No data | 801 BEVILLE ROAD, SOUTH DAYTONA, FL, 32119 |
| G13000016182 | COASTAL SPINE & NEUROLOGY CENTERS | EXPIRED | 2013-02-15 | 2018-12-31 | No data | 725 WEST GRANADA BLVD., SUITE 18-29, ORMOND BEACH, FL, 32174 |
| G13000006376 | COASTAL NEUROLOGY, PAIN AND REHABILIATION CENTERS | EXPIRED | 2013-01-18 | 2018-12-31 | No data | 801 BEVILLE ROAD, 2UITE 101, SOUTH DAYTONA, FL, 32119 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-06 | 725 W Granada Blvd, Suite 22, Ormond Beach, FL 32174 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-03-30 | Brown, Jeremy | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-30 | 725 W Granada Blvd, Suite 22, Ormond Beach, FL 32174 | No data |
| AMENDMENT | 2018-10-23 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-20 | 725 W Granada Blvd, Suite 22, Ormond Beach, FL 32174 | No data |
| AMENDED AND RESTATEDARTICLES/NAME CHANGE | 2002-06-03 | COASTAL NEUROLOGY, INC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-15 |
| ANNUAL REPORT | 2024-04-06 |
| ANNUAL REPORT | 2023-04-09 |
| ANNUAL REPORT | 2022-04-19 |
| ANNUAL REPORT | 2021-03-30 |
| ANNUAL REPORT | 2020-05-11 |
| ANNUAL REPORT | 2019-04-24 |
| Amendment | 2018-10-23 |
| ANNUAL REPORT | 2018-04-24 |
| Reg. Agent Change | 2017-12-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
