| Entity Name: | IMAD AL-NAKSHABENDI, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 01 Oct 2004 (20 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 02 Feb 2020 (5 years ago) |
| Document Number: | P04000136966 |
| FEI/EIN Number | 020732411 |
| Address: | 5041 WESLEY DR, TAMPA, FL, 33647 |
| Mail Address: | 5041 WESLEY DR, TAMPA, FL, 33647 |
| ZIP code: | 33647 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093995821 | 2007-11-08 | 2021-04-21 | 5041 WESLEY DR, TAMPA, FL, 336471376, US | 671 S KINGS AVE, BRANDON, FL, 335116048, US | |||||||||||||||||||||||||
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| Phone | +1 813-972-3750 |
| Fax | 8139723749 |
Authorized person
| Name | DR. IMAD AL-NAKSHABENDI |
| Role | PRESIDENT |
| Phone | 8139723750 |
Taxonomy
| Taxonomy Code | 207RG0100X - Gastroenterology Physician |
| License Number | ME79277 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 261817600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Imad M Al-Nakshabendi | Agent | 5041 WESLEY DR, TAMPA, FL, 33647 |
| Name | Role | Address |
|---|---|---|
| AL-NAKSHABENDI IMAD M | President | 5041 WESLEY DR, TAMPA, FL, 33647 |
| Name | Role | Address |
|---|---|---|
| Al-Nakshabendi Eman | Secretary | 5041 WESLEY DR, TAMPA, FL, 33647 |
| Name | Role | Address |
|---|---|---|
| Nakshabendi Rahman | Director | 5041 WESLEY DR, TAMPA, FL, 33647 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2020-02-02 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-02-02 | Imad M Al-Nakshabendi | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-11-01 | 5041 WESLEY DR, TAMPA, FL 33647 | No data |
| CHANGE OF MAILING ADDRESS | 2007-11-01 | 5041 WESLEY DR, TAMPA, FL 33647 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-11-01 | 5041 WESLEY DR, TAMPA, FL 33647 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-19 |
| ANNUAL REPORT | 2024-03-05 |
| ANNUAL REPORT | 2023-02-05 |
| ANNUAL REPORT | 2022-03-01 |
| ANNUAL REPORT | 2021-08-08 |
| REINSTATEMENT | 2020-02-02 |
| ANNUAL REPORT | 2018-02-06 |
| ANNUAL REPORT | 2017-01-07 |
| ANNUAL REPORT | 2016-01-28 |
| ANNUAL REPORT | 2015-04-30 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 6475137108 | 2020-04-14 | 0455 | PPP | 5041 WESLEY DR, TAMPA, FL, 33647-1376 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Feb 2025
Sources: Florida Department of State
