| Entity Name: | S. MARK BURNETT, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 12 Jun 1991 (34 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 12 Oct 2023 (a year ago) |
| Document Number: | S62255 |
| FEI/EIN Number | 65-0269434 |
| Mail Address: | 4919 Memorial Highway, Suite 150, Tampa, FL 33634 |
| Address: | 1545 MOUND ST, SARASOTA, FL 34236 |
| ZIP code: | 34236 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639468101 | 2011-04-05 | 2011-04-05 | 1545 MOUND ST, SARASOTA, FL, 342367787, US | 1545 MOUND ST, SARASOTA, FL, 342367787, US | |||||||||||||||||||
|
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| Phone | +1 941-957-3376 |
| Fax | 9419511966 |
Authorized person
| Name | S. MARK BURNETT |
| Role | PRESIDENT |
| Phone | 9419573376 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | ME0049399 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Jackson, Matthew | Agent | 4919 Memorial Highway, Suite 150, Tampa, FL 33634 |
| Name | Role | Address |
|---|---|---|
| BURNETT, STEVEN | Director | 19748 GULF BLVD., INDIAN SHORES, FL 33785 |
| Name | Role | Address |
|---|---|---|
| Ross, Amy | Chief Executive Officer | 1545 MOUND ST, SARASOTA, FL 34236 |
| Name | Role | Address |
|---|---|---|
| Jackson, Matthew D | Chief Financial Officer | 4919 Memorial Highway, Suite 150 Tampa, FL 33634 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000070719 | BURNETT DERMATOLOGY | ACTIVE | 2010-08-01 | 2025-12-31 | No data | 1545 MOUND STREET, SARASOTA, FL, 34236 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2023-10-12 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-10-12 | Jackson, Matthew | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-29 | 1545 MOUND ST, SARASOTA, FL 34236 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-29 | 4919 Memorial Highway, Suite 150, Tampa, FL 33634 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1997-03-07 | 1545 MOUND ST, SARASOTA, FL 34236 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| REINSTATEMENT | 2023-10-12 |
| ANNUAL REPORT | 2022-03-29 |
| ANNUAL REPORT | 2021-04-09 |
| ANNUAL REPORT | 2020-01-31 |
| ANNUAL REPORT | 2019-03-30 |
| ANNUAL REPORT | 2018-04-15 |
| ANNUAL REPORT | 2017-04-21 |
| ANNUAL REPORT | 2016-04-24 |
| ANNUAL REPORT | 2015-04-11 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
