| Entity Name: | AHMAD TARIQ ISMAIL LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 17 Oct 2012 (12 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | L12000132703 |
| Address: | 110 EAST BYRD AVENUE, BONIFAY, FL, 32425 |
| Mail Address: | 110 EAST BYRD AVENUE, BONIFAY, FL, 32425 |
| ZIP code: | 32425 |
| County: | Holmes |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952697575 | 2011-06-22 | 2011-06-22 | 110 E BYRD AVE, BONIFAY, FL, 324253004, US | 110 E BYRD AVE, BONIFAY, FL, 324253004, US | |||||||||||||||||||||||||
|
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| Phone | +1 850-547-4799 |
| Fax | 8505472305 |
Authorized person
| Name | MISS CAROL L CURRY |
| Role | OFFICE MANAGER |
| Phone | 8505474799 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME44907 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 66005600 |
| State | FL |
| Name | Role |
|---|---|
| SPIEGEL & UTRERA, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| ISMAIL AHMAD TARIQ | Manager | 110 EAST BYRD AVENUE, BONIFAY, FL, 32425 |
| ISMAIL FATIMA | Manager | 110 EAST BYRD AVENUE, BONIFAY, FL, 32425 |
| Name | Role | Address |
|---|---|---|
| ISMAIL HUMZA | Secretary | 110 EAST BYRD AVENUE, BONIFAY, FL, 32425 |
| Name | Role | Address |
|---|---|---|
| ISMAIL OSAMA | Treasurer | 110 EAST BYRD AVENUE, BONIFAY, FL, 32425 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2012-10-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
