License Verification

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DIANA MICHELLE PETRUK

License Number: PA9108430

Data As Of 6/23/2024

Profession
Physician Assistant
License
PA9108430
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
12/17/2014
Address of Record
1600 South Andrews Ave
Broward Health Medical Center
FORT LAUDERDALE, FL 33316
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
ABRAM, ELIZABETH SIEGEL Supervising Prescribing Practitioner Medical Doctor 126333 09/07/2017
ALVAREZ-AMBAS, AYTANA Supervising Prescribing Practitioner Medical Doctor 135012 02/17/2020
BOEHM, KEVIN MACKE Supervising Prescribing Practitioner Osteopathic Physician 14992 02/11/2018
CHISHOLM, ROBERT WILLIAM Supervising Prescribing Practitioner Medical Doctor 144459 06/01/2020
DOBRINSKY, JONATHAN MICHAEL Supervising Prescribing Practitioner Medical Doctor 131113 03/07/2018
FERENC, MACIEJ Supervising Prescribing Practitioner Osteopathic Physician 8400 08/17/2018
GAFFLEY, REBECCA Supervising Prescribing Practitioner Medical Doctor 135501 02/17/2020
GIANOPOULOS, CHRISTIAN Supervising Prescribing Practitioner Osteopathic Physician 15259 12/22/2020
GUERDAN, BRUCE ROBINSON MD Supervising Prescribing Practitioner Medical Doctor 69024 04/21/2015
HARRISON, CRAIG ERIC Supervising Prescribing Practitioner Medical Doctor 130667 01/23/2018
JONES, KIMBERLEY LOUISE Supervising Prescribing Practitioner Medical Doctor 110129 05/07/2015
KELLEY, WILLIAM THOMAS Supervising Prescribing Practitioner Medical Doctor 110158 04/21/2015
LALLY, BRENDAN JOHN Supervising Prescribing Practitioner Medical Doctor 136054 02/17/2020
LOUDEN, MARK STUART Supervising Prescribing Practitioner Medical Doctor 109541 08/17/2018
MANSOUR, JASON ANTHONY Supervising Prescribing Practitioner Medical Doctor 96393 11/22/2020
MENENDEZ, BENNY Supervising Prescribing Practitioner Medical Doctor 63963 08/17/2018
MIGLIETTA, MARIO ADRIAN Supervising Prescribing Practitioner Osteopathic Physician 11080 05/20/2020
NIEVES, EDMARA Supervising Prescribing Practitioner Medical Doctor 131816 02/17/2020
OBRADOVIC, JOVANA Supervising Prescribing Practitioner Medical Doctor 139313 11/24/2020
OLIVA, JOSEPH WAYNE Supervising Prescribing Practitioner Osteopathic Physician 10074 08/17/2018
OMATSEYE, JIM ORITSETIMEYIN JR Supervising Prescribing Practitioner Medical Doctor 109386 12/22/2020
PALMER, BRET LARRY Supervising Prescribing Practitioner Medical Doctor 114494 08/17/2018
PARTRICK, MATTHEW SEAMUS MD Supervising Prescribing Practitioner Medical Doctor 110989 05/07/2015
POLERA, CATHERINE BEATRICE Supervising Prescribing Practitioner Osteopathic Physician 11336 02/17/2020
QUEEN, RYAN STEPHEN Supervising Prescribing Practitioner Medical Doctor 130879 02/17/2020
SMITH, EDWARD SIDNEY Supervising Prescribing Practitioner Medical Doctor 118968 08/17/2018
TAN, TEAN-SU Supervising Prescribing Practitioner Osteopathic Physician 9091 02/14/2018
TURNER, DAVID A Supervising Prescribing Practitioner Osteopathic Physician 11791 03/07/2018
VAN SMITH, CHRISTOPHER DAVID Supervising Prescribing Practitioner Osteopathic Physician 9487 03/07/2018
YEH, RONALD NGA Supervising Prescribing Practitioner Medical Doctor 96373 06/17/2018

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Name Relationship Profession License Effective Date

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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.