License Verification

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KATHLEEN MARIE CULLEN

License Number: PA2743

Data As Of 11/22/2024

Profession
Physician Assistant
License
PA2743
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
02/11/1994
Address of Record
21202 Olean Blvd
Unit C-1
PORT CHARLOTTE, FL 33952
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
21298 OLEAN BLVD. FAWCETT MEMORIAL
PORT CHARLOTTE, FL 33952
Address
2500 HARBOR BLVD ShorePoint Health Port Charlotte
PORT CHARLOTTE, FL 33952
Address
809 E. MARION AVE. ShorePoint Health Punta Gorda
PUNTA GORDA, FL 33950
Name Relationship Profession License Effective Date
BODINE, BIRGIT UTE Supervising Prescribing Practitioner Medical Doctor 92941 07/01/2022
JEAN, SAMANTHA Supervising Prescribing Practitioner Medical Doctor 132410 07/21/2022
JEAN-SMITH, GERDIE Supervising Prescribing Practitioner Medical Doctor 136348 01/01/2024
KAMAL, AHSAN Supervising Prescribing Practitioner Medical Doctor 97373 07/14/2022
KAMAL, ASIF Supervising Prescribing Practitioner Medical Doctor 71572 09/11/2019
KIRI, NANDINI Supervising Prescribing Practitioner Medical Doctor 82594 07/01/2022
NEWCOMB, CHRISTOPHER FREDERICK Supervising Prescribing Practitioner Medical Doctor 99075 01/01/2024

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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.