| Entity Name: | NIERMALA RATTAN-WASHINGTON, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 27 Jun 2003 (22 years ago) |
| Document Number: | P03000071777 |
| FEI/EIN Number | 611450796 |
| Mail Address: | 2137 SEA PINES WAY, CORAL SPRINGS, FL, 33071 |
| Address: | 7316 W. Atlantic Blvd, Margate, FL, 33063, US |
| ZIP code: | 33063 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1225209919 | 2008-03-20 | 2016-01-13 | 2137 SEA PINES WAY, CORAL SPRINGS, FL, 330717738, US | 3511 NW 8TH AVE, SUITE 2, POMPANO BEACH, FL, 330643055, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 954-288-4481 |
| Fax | 9547830622 |
| Phone | +1 954-783-0621 |
| Fax | 9542555607 |
Authorized person
| Name | DR. NIERMALA WASHINGTON |
| Role | PRESIDENT |
| Phone | 9542884481481 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME90568 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 271039100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BLOOMGARDEN PAUL M | Agent | 8551 W SUNRISE BLVD #208, FT LAUDERDALE, FL, 33322 |
| Name | Role | Address |
|---|---|---|
| RATTAN-WASHINGTON NIERMALA D | President | 2137 SEA PINES WAY, CORAL SPRINGS, FL, 33071 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-08 | 7316 W. Atlantic Blvd, Margate, FL 33063 | No data |
| CHANGE OF MAILING ADDRESS | 2004-10-05 | 7316 W. Atlantic Blvd, Margate, FL 33063 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J22000449902 | ACTIVE | 1000000933878 | BROWARD | 2022-09-14 | 2032-09-21 | $ 437.50 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-03-04 |
| ANNUAL REPORT | 2022-03-23 |
| ANNUAL REPORT | 2021-03-20 |
| ANNUAL REPORT | 2020-05-18 |
| ANNUAL REPORT | 2019-03-16 |
| ANNUAL REPORT | 2018-03-21 |
| ANNUAL REPORT | 2017-04-08 |
| ANNUAL REPORT | 2016-03-24 |
| ANNUAL REPORT | 2015-04-15 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
