License Verification

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KEVIN SHANE CLARK

License Number: PA9108797

Data As Of 11/22/2024

Profession
Physician Assistant
License
PA9108797
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
06/24/2015
Address of Record
740 Dunlawton Ave.
PORT ORANGE, FL 32127
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
239 North Ridgewood Ave.
EDGEWATER, FL 32132
Address
350 NORTH CLYDE MORRIS BLVD.
DAYTONA BEACH, FL 32114
Address
309 & 315 PALM COAST PARKWAY
PALM COAST, FL 32137
Address
937 N. SPRING GARDENS AVENUE
DELAND, FL 32720
Address
1182 OCEAN SHORE BLVD.
ORMOND BEACH, FL 32176
Address
1340 RIDGEWOOD AVENUE
HOLLY HILL, FL 32117
Address
320 NORTH CLYDE MORRIS BLVD.
DAYTONA BEACH, FL 32114
Address
201 NORTH CLYDE MORRIS BLVD.
DAYTONA BEACH, FL 32114
Address
2777 ENTERPRISE RD.
ORANGE CITY, FL 32763
Address
461 S. NOVA RD.
ORMOND BEACH, FL 32174
Address
1184 OCEAN SHORE BLVD.
ORMOND BEACH, FL 32176
Name Relationship Profession License Effective Date
ASIHENE, REGINA JOSEPHINE Supervising Prescribing Practitioner Medical Doctor 75732 06/09/2016
MILCARSKY, EDWARD JOSEPH MD Supervising Prescribing Practitioner Medical Doctor 58714 06/09/2016
ROSATI, SAMUEL M Supervising Prescribing Practitioner Medical Doctor 103357 06/09/2016

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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 11/22/2024



* 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.