| Entity Name: | PARABRAHMA PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 28 Jan 2019 (6 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | P19000009545 |
| Address: | 6100 GREENLAND ROAD #301, JACKSONVILLE, FL, 32258, US |
| Mail Address: | 206 CLIFTON PARK CIRCLE, WILMINGTON, DE, 19802, US |
| ZIP code: | 32258 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912462771 | 2019-02-06 | 2020-04-16 | 6100 GREENLAND RD STE 301, JACKSONVILLE, FL, 322582626, US | 6100 GREENLAND RD STE 301, JACKSONVILLE, FL, 322582626, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 904-337-9494 |
| Fax | 9042931328 |
Authorized person
| Name | NETRALI PATEL |
| Role | PRESIDENT |
| Phone | 9043379494 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207QA0000X - Adolescent Medicine (Family Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 207QA0401X - Addiction Medicine (Family Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207QG0300X - Geriatric Medicine (Family Medicine) Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 102224300 |
| State | FL |
| Issuer | MEDICAID |
| Number | 102515400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PATEL ASHISHKUMAR | Agent | 8396 HEDGEWOOD DR, JACKSONVILLE, FL, 32216 |
| Name | Role | Address |
|---|---|---|
| PATEL NETRALI | President | 6100 GREENLAND ROAD #301, JACKSONVILLE, FL, 32258 |
| Name | Role | Address |
|---|---|---|
| PATEL NETRALI | Secretary | 6100 GREENLAND ROAD #301, JACKSONVILLE, FL, 32258 |
| Name | Role | Address |
|---|---|---|
| PATEL NETRALI | Treasurer | 6100 GREENLAND ROAD #301, JACKSONVILLE, FL, 32258 |
| Name | Role | Address |
|---|---|---|
| PATEL NETRALI | Director | 6100 GREENLAND ROAD #301, JACKSONVILLE, FL, 32258 |
| PATEL ASHISHKUMAR | Director | 6100 GREENLAND ROAD #301, JACKSONVILLE, FL, 32258 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000044785 | CENTER OF EXCELLENCE IN FAMILY & GERIATRIC CARE | ACTIVE | 2020-04-23 | 2025-12-31 | No data | 6100 GREENLAND ROAD SUITE 301, JACKSONVILLE, FL, 32258 |
| G20000044797 | CHILDREN & FETAL HEART INSTITUTE OF AMERICA | ACTIVE | 2020-04-23 | 2025-12-31 | No data | 6100 GREENLAND ROAD SUITE 301, JACKSONVILLE, FL, 32258 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J21000235386 | TERMINATED | 1000000888356 | COLUMBIA | 2021-05-07 | 2031-05-12 | $ 809.48 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, LEESBURG SERVICE CENTER, 900 N 14TH ST STE 201, LEESBURG FL347483817 |
| Name | Date |
|---|---|
| Domestic Profit | 2019-01-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
