License Verification

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SANDRA GAUTIER BLACKMAN

License Number: PA9114259

Data As Of 11/22/2024

Profession
Physician Assistant
License
PA9114259
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
04/01/2021
Address of Record
12902 USF 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
10920 McKinley Drive
TAMPA, FL 33612
Name Relationship Profession License Effective Date
BINITIE, OMOHODION TEMISANJU Supervising Prescribing Practitioner Medical Doctor 117296 10/22/2021
BROHL, ANDREW SCOTT Supervising Prescribing Practitioner Medical Doctor 124615 05/01/2023
DRUTA, MIHAELA Supervising Prescribing Practitioner Medical Doctor 105325 05/01/2023
GONZALEZ, RICARDO JORGE M D Supervising Prescribing Practitioner Medical Doctor 102674 06/07/2021
JOYCE, DAVID MICHAEL Supervising Prescribing Practitioner Medical Doctor 124660 05/01/2023
LAZARIDES, ALEXANDER LEANDROS Supervising Prescribing Practitioner Medical Doctor 156347 08/30/2022
MULLINAX, JOHN ELLIS Supervising Prescribing Practitioner Medical Doctor 107440 06/07/2021
VOSS, RACHEL KAYE Supervising Prescribing Practitioner Medical Doctor 150959 04/14/2023

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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.


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