License Verification

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HEIDI-MARIE ALEXANDRA KELLOCK M.D.

License Number: ME114140

Data As Of 5/19/2024

Profession
Medical Doctor
License
ME114140
License Status
CLEAR/Active
License Expiration Date
1/31/2025
License Original Issue Date
09/06/2012
Address of Record
601 E Rollins Street
ORLANDO, FL 32803
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date
PANDYA, KETAN Supervisor Medical Doctor 85671 09/01/2017
PATTANI, SANJAY J Supervisor Medical Doctor 107131 09/01/2017
PELUSO, VANESSA CHRISTINE Supervisor Medical Doctor 89189 09/01/2017
PEREZ, KIRSA FRIDAL Supervisor Medical Doctor 91119 09/01/2017
POOLE, RICHARD M DO Supervisor Osteopathic Physician 13735 09/01/2017
POOLE, WILLIAM RANDALL Supervisor Medical Doctor 51112 09/01/2017

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Name Relationship Profession License Effective Date
BABBS, GARRETT ADAM Prescribing Physician Assistant Physician Assistant 9108798 3/1/2017
BACH, MADELINE Prescribing Physician Assistant Physician Assistant 9109682 6/28/2017
CORINTH, TASHA Prescribing Physician Assistant Physician Assistant 9110450 1/5/2018
DAILEY, CHRISTY A Prescribing Physician Assistant Physician Assistant 9103849 11/18/2016
KNOTEN, LAUREN Prescribing Physician Assistant Physician Assistant 9110039 1/3/2017
MAYNARD, TIMOTHY RONALD Prescribing Physician Assistant Physician Assistant 9108404 10/18/2017
O'SHELL, COLLEEN MARIE Prescribing Physician Assistant Physician Assistant 9109521 8/5/2016
SUSSMAN, MICHAEL LORNE Prescribing Physician Assistant Physician Assistant 9107280 2/8/2016

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 5/19/2024



* 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.