| Entity Name: | ASHFAQ KUDIA, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Jan 2003 (22 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 30 Jul 2015 (10 years ago) |
| Document Number: | P03000011272 |
| FEI/EIN Number | 593679542 |
| Address: | 1301 PLANTATION ISLAND DRIVE, SUITE 302A, ST. AUGUSTINE, FL, 32080, US |
| Mail Address: | P.O. BOX 3208, ST. AUGUSTINE, FL, 32085, US |
| ZIP code: | 32080 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265675219 | 2009-04-07 | 2010-07-12 | PO BOX 3208, SUITE 302A, SAINT AUGUSTINE, FL, 320853208, US | 1301 PLANTATION ISLAND DR S, SUITE 302A, SAINT AUGUSTINE, FL, 320803108, US | |||||||||||||||||||||||||||||||
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| Phone | +1 904-461-9330 |
| Fax | 9044619331 |
Authorized person
| Name | MRS. FURRIN KUDIA |
| Role | OFFICE MANAGER |
| Phone | 9044619330 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME0068850 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BC/BS |
| Number | 28138 |
| State | FL |
| Issuer | MEDICAID |
| Number | 379026600 |
| State | FL |
| Name | Role |
|---|---|
| CLUKEY & TEBAULT, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| KUDIA ASHFAQ L | President | 1301 PLANTATION ISLAND DRIVE, SUITE 302A, ST. AUGUSTINE, FL, 32080 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2020-06-12 | CLUKEY & TEBAULT LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-12 | 201 Owens Ave, ST. AUGUSTINE, FL 32080 | No data |
| REINSTATEMENT | 2015-07-30 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-03-14 | 1301 PLANTATION ISLAND DRIVE, SUITE 302A, ST. AUGUSTINE, FL 32080 | No data |
| PENDING REINSTATEMENT | 2011-06-08 | No data | No data |
| REINSTATEMENT | 2011-06-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CANCEL ADM DISS/REV | 2008-12-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-29 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-06-12 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-01-29 |
| ANNUAL REPORT | 2017-01-06 |
| ANNUAL REPORT | 2016-04-18 |
| REINSTATEMENT | 2015-07-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
