License Verification

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NICOLE MARIE ANTENUCCI

License Number: PA9109691

Data As Of 11/22/2024

Profession
Physician Assistant
License
PA9109691
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
08/04/2016
Address of Record
St. Vincent's Medical Center S
4201 Belfort Rd
JACKSONVILLE, FL 32216
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
Ascension St Vincents Riverside Hospital 3 Shircliff Way #714
JACKSONVILLE, FL 32204
Name Relationship Profession License Effective Date
ANDERSON, BRANDON HAYDEN Supervising Prescribing Practitioner Medical Doctor 82728 10/01/2017
ANDERSON, BRIAN DAVID Supervising Prescribing Practitioner Osteopathic Physician 12156 09/29/2017
ARAGONA, JODI L Supervising Prescribing Practitioner Medical Doctor 100638 10/01/2017
CONSIDINE, KATHERINE VAUGHT Supervising Prescribing Practitioner Medical Doctor 45977 10/01/2017
DURAN-GEHRING, PETRA E Supervising Prescribing Practitioner Medical Doctor 91161 08/14/2017
GEHRING, JEFFREY SCOTT MD Supervising Prescribing Practitioner Medical Doctor 97562 08/14/2017
GERMAN, KATHERINE TUCKER Supervising Prescribing Practitioner Medical Doctor 147370 11/17/2020
GUIRGIS, FAHEEM WAGID Supervising Prescribing Practitioner Medical Doctor 106205 10/05/2017
GUY, KRISTEN Supervising Prescribing Practitioner Medical Doctor 131038 03/20/2018
JOHNSON, JENNIFER BURKE Supervising Prescribing Practitioner Medical Doctor 115159 10/12/2017
KENNEDY, GILBERT MCDERMOTT Supervising Prescribing Practitioner Medical Doctor 88046 08/11/2017
KLINE, CHRISTOPHER JOHN Supervising Prescribing Practitioner Medical Doctor 79148 08/14/2017
LEDERER, ERIC Supervising Prescribing Practitioner Medical Doctor 135372 08/22/2018
MAUZY, JENNIFER LYNN Supervising Prescribing Practitioner Medical Doctor 115191 09/27/2017
MILES, TANNER DAVID Supervising Prescribing Practitioner Medical Doctor 144233 06/21/2020
PASCHALL, CHRISTOPHER Supervising Prescribing Practitioner Medical Doctor 96392 09/28/2017
SMITH, TRAVIS MICHAEL Supervising Prescribing Practitioner Osteopathic Physician 11602 08/11/2017
SWENSON, MELISSA MARGARET Supervising Prescribing Practitioner Medical Doctor 138587 04/08/2019
VOLK, JILL GOLDSTEIN Supervising Prescribing Practitioner Osteopathic Physician 13975 11/01/2019

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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.