License Verification

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KYLE JONATHAN CALLAHAN

License Number: PA9109286

Data As Of 11/22/2024

Profession
Physician Assistant
License
PA9109286
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
12/22/2015
Address of Record
2627 West Eau Gaille Blvd.
Suite 101
MELBOURNE, FL 32935
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
701 W Cocoa Beah CSWY Cape Canaveral Hospital
COCOA BEACH, FL 32931
Address
1425 MALABAR RD. N.E. PALM BAY HOSPITAL
PALM BAY, FL 32907
Address
1350 SOUTH HICKORY STREET HOLMES REGIONAL MEDICAL CENTER
MELBOURNE, FL 32901
Address
8745 North Wickham Rd Viera Hospital
VIERA, FL 32940
Name Relationship Profession License Effective Date
AGOSTO DIAZ, EDIL J Supervising Prescribing Practitioner Medical Doctor 102761 05/05/2016
ALVAREZ, COREY Supervising Prescribing Practitioner Medical Doctor 131625 09/20/2017
BANAPOOR, BENJAMIN Supervising Prescribing Practitioner Medical Doctor 156442 11/01/2022
BRONSTEMA, CLARENCE JAMES DO Supervising Prescribing Practitioner Osteopathic Physician 9722 05/05/2016
BROWN, MARTY RAY M D Supervising Prescribing Practitioner Medical Doctor 75648 05/05/2016
CSORTAN, ERIC STEVEN Supervising Prescribing Practitioner Medical Doctor 84708 05/05/2016
DEVAUX, MIKAELA ELISE Supervising Prescribing Practitioner Medical Doctor 130853 06/14/2021
DEVEREAUX, DANIELLE Supervising Prescribing Practitioner Medical Doctor 129224 10/26/2016
DUDLEY, LARISSA SOPHIA Supervising Prescribing Practitioner Medical Doctor 131434 09/20/2017
GAGEN, JAMES SHAWN Supervising Prescribing Practitioner Osteopathic Physician 10263 05/05/2016
GILROY, RONALD THOMAS MD Supervising Prescribing Practitioner Medical Doctor 61905 05/05/2016
GREEN, DOUGLAS WARREN MD Supervising Prescribing Practitioner Medical Doctor 81481 05/05/2016
GRIFFIN, JOHN PATRICK MD Supervising Prescribing Practitioner Medical Doctor 78523 05/05/2016
GUTTA, RAJESH Supervising Prescribing Practitioner Medical Doctor 82886 05/05/2016
HEIST, DORAN ROBERT MD Supervising Prescribing Practitioner Medical Doctor 111822 02/25/2021
HOMERICK, MICHAEL JOHN Supervising Prescribing Practitioner Medical Doctor 119113 09/14/2016
JOCKOVICH, MILAN MD Supervising Prescribing Practitioner Medical Doctor 65559 05/05/2016
JONES JR, PRESTON M Supervising Prescribing Practitioner Medical Doctor 162801 08/17/2023
LLINAS, JACQUELINE B MD Supervising Prescribing Practitioner Medical Doctor 68727 05/05/2016
MATHEW, DANA RICHARDS MD Supervising Prescribing Practitioner Medical Doctor 128175 09/14/2016
MCGOOHAN, MICHAEL PATRICK DO Supervising Prescribing Practitioner Osteopathic Physician 6325 06/08/2021
MILES, JAMES TIMOTHY Supervising Prescribing Practitioner Medical Doctor 76017 05/05/2016
OLIVEIRA, BRIAN MARIO Supervising Prescribing Practitioner Medical Doctor 110586 05/05/2016
OSWALD, NED ANTHONY MD Supervising Prescribing Practitioner Medical Doctor 121076 05/05/2016
PIRAZZI-MARQUEZ, BEATRIZ M Supervising Prescribing Practitioner Medical Doctor 102083 05/05/2016
RAMAGE, DARRON TRAVIS Supervising Prescribing Practitioner Medical Doctor 115024 06/08/2021
ROTOLO, ALYSSA BIXBY Supervising Prescribing Practitioner Medical Doctor 127035 11/27/2018
ST CLAIR, AARON LEE Supervising Prescribing Practitioner Medical Doctor 106075 05/05/2016
STOJANOVSKI, MIHAIL METODIJA Supervising Prescribing Practitioner Medical Doctor 130869 09/20/2017
TYMKOWICZ, ALEXANDRIA Supervising Prescribing Practitioner Medical Doctor 156308 03/14/2023
VAZQUEZ, JOHNNY J Supervising Prescribing Practitioner Medical Doctor 97644 05/05/2016
WEBER, DOUGLAS ANTHONY Supervising Prescribing Practitioner Medical Doctor 143900 05/01/2020
WEEMAN, MITCHELL Supervising Prescribing Practitioner Medical Doctor 160791 07/26/2023

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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.