License Verification

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ELIZABETH CORRINE BAGLEY WONPAT

License Number: ME101685

Data As Of 6/23/2024

Profession
Medical Doctor
License
ME101685
License Status
CLEAR/Active
License Expiration Date
1/31/2026
License Original Issue Date
05/19/2008
Address of Record
2052 Rivergate Drive
ORANGE PARK, FL 32003
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
Yes
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date
BROCETA MARTINEZ, ABELARDO Supervising Prescribing Practitioner Medical Doctor 158493 06/06/2024
CRUZ, ALEXANDRA Supervising Prescribing Practitioner Osteopathic Physician 19813 05/14/2024
DRURY, TYLER BARRETT Supervising Prescribing Practitioner Osteopathic Physician 20206 05/13/2024
JIMENEZ, ANGELICA ROCIO MD Supervising Prescribing Practitioner Medical Doctor 95805 04/02/2024
LOPEZ, CARLOS ADRIAN Supervising Prescribing Practitioner Medical Doctor 127222 06/05/2024
VENUTI, NICHOLAS STEPHEN Supervising Prescribing Practitioner Medical Doctor 161734 05/28/2024

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Name Relationship Profession License Effective Date
BURDEN, CHARITY Prescribing Physician Assistant Physician Assistant 9117433 5/22/2024
CANTOR, LUIS Prescribing Physician Assistant Physician Assistant 9113587 4/3/2024
CHEN, AMY Prescribing Physician Assistant Physician Assistant 9115760 3/11/2024
DIENELL, KATIE Prescribing Physician Assistant Physician Assistant 9117206 1/17/2024
KHAN, FARIHAH Prescribing Physician Assistant Physician Assistant 9111876 4/22/2024
KIMBLE, TIFFANY ANNE Prescribing Physician Assistant Physician Assistant 9105875 1/17/2024
KORNETTI, BRIANNE NICOLE Prescribing Physician Assistant Physician Assistant 9118683 5/22/2024
PERICLES, ADALYNE Prescribing Physician Assistant Physician Assistant 9107848 5/30/2024
PUTMAN, LESLIE SUE Prescribing Physician Assistant Physician Assistant 3042 1/17/2024
RAZZAQ, MARIA Prescribing Physician Assistant Physician Assistant 9111979 1/17/2024
SHAFII, LATIFEH Prescribing Physician Assistant Physician Assistant 9112064 4/3/2024
UMANSKY, BETH LAUREN Prescribing Physician Assistant Physician Assistant 9107407 1/17/2024
VAN FOSSEN, JAMES WILLIAM Prescribing Physician Assistant Physician Assistant 9118780 6/6/2024
VIGROUX, BETHANY NICOLE Prescribing Physician Assistant Physician Assistant 9107323 4/3/2024

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 6/23/2024



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


For instructions on how to request a license certification of your Florida license to be sent to another state from the Florida Department of Health, please visit the License Certifications web page.