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TIMOTHY RONALD MAYNARD

License Number: PA9108404

Data As Of 5/6/2024

Profession
Physician Assistant
License
PA9108404
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
11/24/2014
Address of Record
Excelis Medical Associates
2502 W. Saint Isabel St
TAMPA, FL 33607
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
Yes
Discipline on File
No
Public Complaint
No
Address
6901 Simmons Loop St. Joseph's Hospital South
RIVERVIEW, FL 33578
Address
3001 W Dr Martin Luther King J St. Joseph's Hospital Tampa
TAMPA, FL 33607
Address
4211 Van Dyke Road St. Joseph's Hospital North
LUTZ, FL 33558
Name Relationship Profession License Effective Date
AGDAMAG, PATRICK LEE Supervising Prescribing Practitioner Medical Doctor 104157 10/17/2017
AGUAYO, ELLIOTT JAMES Supervising Prescribing Practitioner Medical Doctor 118692 10/17/2017
ATEZ, FRANCISCO JOSE Supervising Prescribing Practitioner Medical Doctor 109582 10/17/2017
BARRON, SCOTT ALAN Supervising Prescribing Practitioner Medical Doctor 107217 10/17/2017
BHATT, SUMEET RAJ MD Supervising Prescribing Practitioner Medical Doctor 107985 10/17/2017
BOLAND, KEVIN PATRICK Supervising Prescribing Practitioner Osteopathic Physician 12732 10/17/2017
BORUCKI, SIMON Supervising Prescribing Practitioner Medical Doctor 104560 10/17/2017
CANO, ROBERT ANTHONY DO Supervising Prescribing Practitioner Osteopathic Physician 7269 10/17/2017
CARABALLO, DAMIAN EDUARDO IV Supervising Prescribing Practitioner Medical Doctor 106340 10/17/2017
CASTANO, FRANCIS FAN M D Supervising Prescribing Practitioner Medical Doctor 64422 10/17/2017
CONLEY, AMY RUBEN Supervising Prescribing Practitioner Medical Doctor 79991 10/17/2017
DAWKINS, DONALD Supervising Prescribing Practitioner Osteopathic Physician 10160 10/17/2017
DE LUCA, LAURIE JEAN Supervising Prescribing Practitioner Medical Doctor 94019 10/17/2017
DEGROAT, JONATHAN THOMAS Supervising Prescribing Practitioner Medical Doctor 114356 10/17/2017
DESAI, AJAY Supervising Prescribing Practitioner Osteopathic Physician 12568 10/17/2017
DIXON, MARK DALE MD Supervising Prescribing Practitioner Medical Doctor 63074 10/17/2017
DRAVIAM, SAMEER P Supervising Prescribing Practitioner Medical Doctor 116541 10/17/2017
DUBEY, JESSE VINCENT Supervising Prescribing Practitioner Osteopathic Physician 13099 10/17/2017
EDGINTON, SIMON ROY M D Supervising Prescribing Practitioner Medical Doctor 74221 10/17/2017
EVERS, NATALIE MARIE Supervising Prescribing Practitioner Medical Doctor 89128 10/17/2017
GELDART, DONALD BLAIR Supervising Prescribing Practitioner Medical Doctor 27412 10/17/2017
GOEHLERT, UWE GUSTAV Supervising Prescribing Practitioner Medical Doctor 86308 10/17/2017
GRANT-LEVY, TATIA R DO Supervising Prescribing Practitioner Osteopathic Physician 7331 10/17/2017
HASKINS, KERRY HUGH MD Supervising Prescribing Practitioner Medical Doctor 49468 10/17/2017
HUMMEL, LAURA Supervising Prescribing Practitioner Medical Doctor 127881 10/17/2017
KALDAS, MAGDY AYAD Supervising Prescribing Practitioner Medical Doctor 71928 10/17/2017
KEILMAN, CLINTON GABRIEL Supervising Prescribing Practitioner Medical Doctor 128366 10/17/2017
KELLOCK, HEIDI-MARIE ALEXANDRA M D Supervising Prescribing Practitioner Medical Doctor 114140 10/18/2017
KHAN, WAJAHAT ULLAH Supervising Prescribing Practitioner Medical Doctor 81138 10/18/2017
KIRTZ, JEREMY FECHTER Supervising Prescribing Practitioner Medical Doctor 108993 10/18/2017
KLEINMAN, DANA Supervising Prescribing Practitioner Osteopathic Physician 11037 10/18/2017
KOONKITTI, PARICHART CANDY Supervising Prescribing Practitioner Medical Doctor 125284 10/18/2017
KUMAR, SIDHARTH KAUSHIK Supervising Prescribing Practitioner Medical Doctor 122215 10/18/2017
LALLY, ARLEEN ANN Supervising Prescribing Practitioner Osteopathic Physician 8845 10/18/2017
LANCASTER, CHRISTINE BARONE Supervising Prescribing Practitioner Medical Doctor 95506 10/17/2017
LAND, LARRY LEE Supervising Prescribing Practitioner Medical Doctor 108914 10/18/2017
LAY, STEVEN F M D Supervising Prescribing Practitioner Medical Doctor 51047 10/18/2017
LEE, EUGENE C Supervising Prescribing Practitioner Medical Doctor 115521 10/18/2017
LONGLEY, MICHAEL BRUCE Supervising Prescribing Practitioner Medical Doctor 94125 10/18/2017
LUCAS, JOANNE BRYAN Supervising Prescribing Practitioner Medical Doctor 97884 10/18/2017
MATHUR, MONAL PATEL Supervising Prescribing Practitioner Medical Doctor 101062 10/18/2017
MATHUR, RAJNEESH Supervising Prescribing Practitioner Osteopathic Physician 10264 10/18/2017
MERRITT, RAYMOND LEE Supervising Prescribing Practitioner Osteopathic Physician 11538 10/18/2017
MIAH, BAHAR Supervising Prescribing Practitioner Medical Doctor 108183 10/18/2017
NASR, RAMY MOHAMED ZAKI MD Supervising Prescribing Practitioner Medical Doctor 117829 10/18/2017
NAZARY, NEK NAZAR Supervising Prescribing Practitioner Medical Doctor 117096 10/18/2017
NESSELROADE, RYAN DAVID Supervising Prescribing Practitioner Medical Doctor 106189 10/18/2017
O'MALLEY, RACHEL ELIZABETH Supervising Prescribing Practitioner Medical Doctor 112862 10/18/2017
OSBORNE, AARON RYAN Supervising Prescribing Practitioner Medical Doctor 108215 10/18/2017
PARTYKA, BRONISLAW J Supervising Prescribing Practitioner Medical Doctor 114822 10/18/2017
PATEL, TEJAS Supervising Prescribing Practitioner Osteopathic Physician 13790 10/18/2017
PAYOR, AUSTIN DANIEL Supervising Prescribing Practitioner Osteopathic Physician 10925 10/18/2017
PERRY, PAMELA MARIA MD Supervising Prescribing Practitioner Medical Doctor 108679 10/18/2017
PIERRO, ANTHONY PETER Supervising Prescribing Practitioner Osteopathic Physician 12031 10/18/2017
PIGMAN, EDWIN CARY MD Supervising Prescribing Practitioner Medical Doctor 66985 10/18/2017
PRATOR, PAUL CARL M D Supervising Prescribing Practitioner Medical Doctor 92865 10/18/2017
SANTAYANA, RICARDO JR Supervising Prescribing Practitioner Medical Doctor 119115 10/18/2017
SECREST, JULIE K Supervising Prescribing Practitioner Medical Doctor 110718 10/18/2017
SHAH, MANASI SAMIR Supervising Prescribing Practitioner Medical Doctor 127451 10/18/2017
SIMPKINS, JANELL LYNN Supervising Prescribing Practitioner Medical Doctor 120613 10/18/2017
SIMPSON, ALISON L Supervising Prescribing Practitioner Medical Doctor 74810 10/18/2017
SPENCER, ANDREW JOSEPH Supervising Prescribing Practitioner Medical Doctor 122767 10/18/2017
STAFF, KRISTINE E Supervising Prescribing Practitioner Medical Doctor 117924 10/18/2017
TAHER, RAMEZ Supervising Prescribing Practitioner Medical Doctor 101043 10/18/2017
TEPPER, EVAN BRETT MD Supervising Prescribing Practitioner Medical Doctor 60190 10/18/2017
THUROW, CHANTELLE LANEE Supervising Prescribing Practitioner Osteopathic Physician 11505 10/18/2017
TICKETT, SHELLEY SMITH Supervising Prescribing Practitioner Medical Doctor 90313 10/18/2017
TIRHEIMER, WENZEL III Supervising Prescribing Practitioner Medical Doctor 83294 10/18/2017
VELASCO, WILLIAM J Supervising Prescribing Practitioner Medical Doctor 121914 10/18/2017
VIBHAKAR, ARJUN Supervising Prescribing Practitioner Medical Doctor 128122 12/07/2016
VOEGTLI, KRYSTYNA RENEE Supervising Prescribing Practitioner Medical Doctor 114913 10/18/2017
WHITE, GREGORY RICHARD MR Supervising Prescribing Practitioner Medical Doctor 39946 10/18/2017
WHITE, JEREMY V Supervising Prescribing Practitioner Osteopathic Physician 11399 10/18/2017
YOHANNES-PETERS, FITSUM Supervising Prescribing Practitioner Medical Doctor 92187 10/18/2017
YONTECK, FREDERICK TODD Supervising Prescribing Practitioner Medical Doctor 87287 10/18/2017
ZAHARIS, CONSTANTINE ZACHARY MD Supervising Prescribing Practitioner Medical Doctor 112437 10/18/2017
ZAHN, ELISE JOY Supervising Prescribing Practitioner Osteopathic Physician 7897 10/18/2017

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No Continuing Education Hours Received from Approved Providers As Of 5/7/2024



* 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.


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