License Verification

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MARIAH WRINKLE

License Number: PA9110612

Data As Of 6/9/2025

Profession
Physician Assistant
License
PA9110612
License Status
CLEAR/Active
Qualifications
Prescribing
Dispensing Practitioner
License Expiration Date
1/31/2026
License Original Issue Date
09/01/2017
Address of Record
1350 13th Street South
JACKSONVILLE BEACH, FL 32250
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
14550 Old St. Augustine road
JACKSONVILLE, FL 32258
Address
1250 S 18TH STREET BAPTIST NASSAU
FERNANDINA BEACH, FL 32034
Address
400 HEALTH PARK BLVD. FLAGLER HOSPITAL
SAINT AUGUSTINE, FL 32086
Address
1 Shircliff Way
JACKSONVILLE, FL 32204
Address
800 prudential Drive
JACKSONVILLE, FL 32207
Address
4201 Belford road
JAX, FL 32216
Name Relationship Profession License Effective Date
HARRIS, ANTHONY MICHAEL Supervising Prescribing Practitioner Medical Doctor 94420 10/29/2018
KEENER, EMILY MAE Supervising Prescribing Practitioner Osteopathic Physician 13589 10/29/2018
TABRIZI, PAYAM Supervising Dispensing Practitioner Medical Doctor 133411 11/13/2018
TABRIZI, PAYAM Supervising Prescribing Practitioner Medical Doctor 133411 12/21/2017

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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 6/9/2025



* 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.