| Entity Name: | DAVID G. CISLO, D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 05 Aug 1992 (32 years ago) |
| Date of dissolution: | 24 Sep 2010 (14 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2010 (14 years ago) |
| Document Number: | V55358 |
| FEI/EIN Number | 65-0356703 |
| Address: | 13815 TAMIAMI TRL, NORTH PORT, FL 34287 |
| Mail Address: | 13815 TAMIAMI TRL, NORTH PORT, FL 34287 |
| ZIP code: | 34287 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346356854 | 2006-08-21 | 2020-08-22 | 13815 TAMIAMI TRL, NORTH PORT MEDICAL CENTER, NORTH PORT, FL, 342872069, US | 13815 TAMIAMI TRL, NORTH PORT MEDICAL CENTER, NORTH PORT, FL, 342872069, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 941-426-4900 |
| Fax | 9414263994 |
Authorized person
| Name | MRS. MICHELLE A ROBILLARD |
| Role | PRACTICE ADMINISTRATOR |
| Phone | 9414264900 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS5665 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | OS6317 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| License Number | ARNP3380712 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| CISLO, DAVID G | Agent | 13815 TAMIAMI TRL, NORTH PORT, FL 34287 |
| Name | Role | Address |
|---|---|---|
| GUTIERREZ, ROBERT F | Vice President | 13815 TAMIAMI TRL, NORTH PORT, FL 34287 |
| Name | Role | Address |
|---|---|---|
| CISLO, DAVID G | President | 13815 TAMIAMI TRL, NORTH PORT, FL 34287 |
| Name | Role | Address |
|---|---|---|
| CISLO, DAVID G | Secretary | 13815 TAMIAMI TRL, NORTH PORT, FL 34287 |
| Name | Role | Address |
|---|---|---|
| CISLO, DAVID G | Treasurer | 13815 TAMIAMI TRL, NORTH PORT, FL 34287 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-02-15 | 13815 TAMIAMI TRL, NORTH PORT, FL 34287 | No data |
| CHANGE OF MAILING ADDRESS | 2006-02-15 | 13815 TAMIAMI TRL, NORTH PORT, FL 34287 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-02-15 | 13815 TAMIAMI TRL, NORTH PORT, FL 34287 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2009-06-25 |
| ANNUAL REPORT | 2008-03-13 |
| ANNUAL REPORT | 2007-02-22 |
| ANNUAL REPORT | 2006-02-15 |
| ANNUAL REPORT | 2005-01-24 |
| ANNUAL REPORT | 2004-02-04 |
| ANNUAL REPORT | 2003-01-21 |
| ANNUAL REPORT | 2002-02-04 |
| ANNUAL REPORT | 2001-07-12 |
| ANNUAL REPORT | 2000-02-24 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
