Detail by Officer/Registered Agent Name

Florida Profit Corporation

FLORIDA HEALTH SOURCE OF TAMPA, INC.

Filing Information
P03000077850 20-0271082 07/10/2003 FL INACTIVE ADMIN DISSOLUTION FOR ANNUAL REPORT 09/16/2005 NONE
Principal Address
350 JIM MORAN BLVD.
DEEFIELD BEACH, FL 33442
Mailing Address
350 JIM MORAN BLVD.
DEEFIELD BEACH, FL 33442
Registered Agent Name & Address BLOOM, JONATHAN ESQ
BLOOM BALTEN AND FREELING
2295 NW CORPORATE BLVD, STE 117
BOCA RATON, FL 33431

Name Changed: 05/03/2004

Address Changed: 05/03/2004
Officer/Director Detail Name & Address

Title PTD

BROVENICK, EVAN
350 JIM MORAN BLVD.
DEEFIELD BEACH, FL 33442

Title S

BLECHMAN, DAVID
350 JIM MORAN BLVD.
DEEFIELD BEACH, FL 33442

Annual Reports
Report YearFiled Date
2004 05/03/2004