| Entity Name: | THE HEADACHE AND NEUROLOGY CLINIC, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Jan 2007 (18 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 12 Apr 2020 (5 years ago) |
| Document Number: | P07000003384 |
| FEI/EIN Number | 41-2226024 |
| Address: | 11323 CORTEZ BLVD., BROOKSVILLE, FL, 34613, US |
| Mail Address: | 11323 CORTEZ BLVD., BROOKSVILLE, FL, 34613, US |
| ZIP code: | 34613 |
| County: | Hernando |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770614786 | 2007-03-08 | 2010-07-06 | 11373 CORTEZ BLVD STE 303, BROOKSVILLE, FL, 346135411, US | 11373 CORTEZ BLVD STE 303, 303, BROOKSVILLE, FL, 346135411, US | |||||||||||||||||||||||
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| Phone | +1 352-596-8344 |
| Fax | 3525972898 |
Authorized person
| Name | DR. QAHTAN ABDULFATTAH |
| Role | PRESIDENT |
| Phone | 3525968344 |
Taxonomy
| Taxonomy Code | 204D00000X - Neuromusculoskeletal Medicine & OMM Physician |
| License Number | ME92671 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PROVIDER'S INDIVIDUAL NPI |
| Number | 1558370411 |
| Name | Role | Address |
|---|---|---|
| Abdulfattah Qahtan | Agent | 11323 CORTEZ BLVD., BROOKSVILLE, FL, 34613 |
| Name | Role | Address |
|---|---|---|
| ABDULFATTAH QAHTAN Dr. | Director | 11323 CORTEZ BLVD., BROOKSVILLE, FL, 34613 |
| Name | Role | Address |
|---|---|---|
| ABDULFATTAH QAHTAN Dr. | President | 11323 CORTEZ BLVD., BROOKSVILLE, FL, 34613 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2020-04-12 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-04-12 | Abdulfattah, Qahtan | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-03-03 | 11323 CORTEZ BLVD., BROOKSVILLE, FL 34613 | No data |
| CHANGE OF MAILING ADDRESS | 2011-03-03 | 11323 CORTEZ BLVD., BROOKSVILLE, FL 34613 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-03-03 | 11323 CORTEZ BLVD., BROOKSVILLE, FL 34613 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-17 |
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-02-27 |
| ANNUAL REPORT | 2022-02-02 |
| ANNUAL REPORT | 2021-04-29 |
| REINSTATEMENT | 2020-04-12 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-03-30 |
| ANNUAL REPORT | 2016-05-09 |
| ANNUAL REPORT | 2015-04-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
