Detail by Officer/Registered Agent Name

Florida Not For Profit Corporation

BREVARD PPO, INC.

Filing Information
N42375 59-3083439 03/06/1991 FL INACTIVE ADMIN DISSOLUTION FOR ANNUAL REPORT 09/22/2000 NONE
Principal Address
110 LONGWOOD AVENUE
P.O. BOX 565002, MS #93
ROCKLEDGE, FL 32955-2828

Changed: 05/01/1994
Mailing Address
110 LONGWOOD AVENUE
P.O. BOX 565002, MS #93
ROCKLEDGE, FL 32955-2828

Changed: 05/01/1994
Registered Agent Name & Address MURPHY, TERENCE M.
110 LONGWOOD AVENUE
ROCKLEDGE, FL 32955

Name Changed: 05/01/1996
Officer/Director Detail Name & Address

Title D

THOMPSON, PAUL DR
110 LONGWOOD AVENUE
ROCKLEDGE, FL 32955-2828

Title D

NIMOCKS, JAMES M.D.
110 LONGWOOD AVENUE
ROCKLEDGE, FL 32955-2828

Title CD

ARNOLD, DONALD DR
134 S WOODS DRIVE
ROCKLEDGE, FL

Title D

MURPHY, TERENCE M.
110 LONGWOOD AVENUE
ROCKLEDGE, FL 32955-2828

Title D

WANICH, CHARLES M.D.
375 S. COURTENAY PKWY.
MERRITT ISLAND, FL

Annual Reports
Report YearFiled Date
1997 05/13/1997
1998 05/19/1998
1999 05/10/1999