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License Number: PA9112147

Data As Of 11/22/2024

Profession
Physician Assistant
License
PA9112147
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
04/16/2019
Address of Record
Moffitt Cancer Center
12902 Magnolia Drive
TAMPA, FL 33612
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
4101 Jim Walter Blvd
TAMPA, FL 33607
Address
2590 healing way suites 100 &200
WESLEY CHAPEL, FL 33544
Name Relationship Profession License Effective Date
AGOSTO SALGADO, SARIMAR NAHOMIS Supervising Prescribing Practitioner Medical Doctor 152001 11/10/2021
CHUNG, CHRISTINE HWAYONG Supervising Prescribing Practitioner Medical Doctor 124938 09/06/2023
HALLANGER -JOHNSON, JULIE ELIZABETH Supervising Prescribing Practitioner Medical Doctor 128712 11/04/2021
KIRTANE, KEDAR Supervising Prescribing Practitioner Medical Doctor 137041 09/12/2023
MONSOUR, ELIO PAUL Supervising Prescribing Practitioner Medical Doctor 161236 08/24/2023
TARASOVA, VALENTINA D Supervising Prescribing Practitioner Medical Doctor 130625 11/13/2021
VELOSKI, COLLEEN Supervising Prescribing Practitioner Medical Doctor 137667 08/09/2019

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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.