| Entity Name: | ANU R TATAMBHOTLA MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Jan 2000 (25 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 21 Oct 2003 (21 years ago) |
| Document Number: | P00000010853 |
| FEI/EIN Number | 593617413 |
| Address: | 4049, SOUTH OHIO AVE, HOMOSASSA, FL, 34446 |
| Mail Address: | P. O. BOX 5069, HOMOSASSA SPRINGS, FL, 34447 |
| ZIP code: | 34446 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114152188 | 2009-05-20 | 2009-05-20 | PO BOX 5069, HOMOSASSA SPRINGS, FL, 344475069, US | 4049 S OHIO AVE, HOMOSASSA, FL, 344461138, US | |||||||||||||||||||||||||||
|
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| Phone | +1 352-628-1000 |
| Fax | 3526281120 |
Authorized person
| Name | DR. ANU R TATAMBHOTLA |
| Role | OWNER |
| Phone | 3526281000 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME73760 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | FLARNP2962952 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| TATAMBHOTLA ANU R | Agent | 2280, NORTH OVERLOOK PATH, HERNANDO, FL, 34442 |
| Name | Role | Address |
|---|---|---|
| TATAMBHOTLA ANU R | Manager | 2280, NORTH OVERLOOK PATH, HERNANDO, FL, 34442 |
| Name | Role | Address |
|---|---|---|
| TATAMBHOTLA ANU R | Director | 2280, NORTH OVERLOOK PATH, HERNANDO, FL, 34442 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08126900399 | GROVER CLEVELAND MEDICAL CENTER | EXPIRED | 2008-05-05 | 2013-12-31 | No data | P O BOX 5069, HOMOSASSA SPRINGS, FL, 34447 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2011-04-29 | 4049, SOUTH OHIO AVE, HOMOSASSA, FL 34446 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-04-28 | 2280, NORTH OVERLOOK PATH, HERNANDO, FL 34442 | No data |
| CHANGE OF MAILING ADDRESS | 2005-03-19 | 4049, SOUTH OHIO AVE, HOMOSASSA, FL 34446 | No data |
| CANCEL ADM DISS/REV | 2003-10-21 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2003-09-19 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-04-22 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-06-06 |
| ANNUAL REPORT | 2019-04-07 |
| ANNUAL REPORT | 2018-03-31 |
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-04-23 |
| ANNUAL REPORT | 2015-04-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
