License Verification

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JARED SHIPLEY

License Number: PA9112971

Data As Of 4/28/2025

Profession
Physician Assistant
License
PA9112971
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
01/24/2020
Address of Record
AdventHealth PCN
9975 Lake Tavistock Lakes Blvd
ORLANDO, FL 32827
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
Yes
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date
FLEMING, JUANITA R Supervising Prescribing Practitioner Medical Doctor 116812 03/18/2020
HUDSON, DIANE CAROLYN Supervising Prescribing Practitioner Medical Doctor 93283 03/18/2020
NYSTROM, JACQUELYN HARTZLER Supervising Prescribing Practitioner Medical Doctor 94368 05/16/2023
SMITH, GEORGE ANDREW W MD Supervising Prescribing Practitioner Medical Doctor 65478 03/18/2020

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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 4/28/2025



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** 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.


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