License Verification

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MACKENZIE LYNN EVANS

License Number: PA9116290

Data As Of 11/23/2024

Profession
Physician Assistant
License
PA9116290
License Status
CLEAR/Active
Qualifications
Prescribing
Dispensing Practitioner
License Expiration Date
1/31/2026
License Original Issue Date
08/16/2022
Address of Record
303 W Palm Ave
TAMPA, FL 33602
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
19027 Wingshooter Way
LUTZ, FL 33558
Address
22945 State Rd 54
LUTZ, FL 33549
Address
2810 W MLK Jr Blvd
TAMPA, FL 33607
Address
13856 N Dale Mabry Hwy
TAMPA, FL 33618
Address
11406 US Hwy 301 S
RIVERVIEW, FL 33578
Address
4949 4th St N
SAINT PETERSBURG, FL 33703
Address
13531 State Rd 54
ODESSA, FL 33556
Address
6182 N US Highway 41
APOLLO BEACH, FL 33572
Address
40545 US Hwy 19N Unit A
TARPON SPRINGS, FL 34689
Address
5464 Lithia Pinecrest Dr
LITHIA, FL 33547
Address
564 Channelside Dr
TAMPA, FL 33602
Address
16521 US Hwy 301 S
WIMAUMA, FL 33573
Address
799 W Lumsden Rd
BRANDON, FL 33511
Address
3251 66th St N
SAINT PETERSBURG, FL 33710
Address
7601 Seminole Blvd
SEMINOLE, FL 33772
Address
4505 Gunn Hwy
TAMPA, FL 33624
Address
11969 Sheldon Rd
TAMPA, FL 33626
Address
5504 Gateway Blvd
WESLEY CHAPEL, FL 33544
Address
3301 W Gandy Blvd
TAMPA, FL 33611
Name Relationship Profession License Effective Date
AHMED, ALTAN FAREED Supervising Prescribing Practitioner Medical Doctor 135276 12/12/2023
AL-ROUBAIE, MUSTAFA Supervising Prescribing Practitioner Medical Doctor 158621 12/02/2023
CHOI, JUNSUNG Supervising Prescribing Practitioner Medical Doctor 63922 12/12/2023
EL-HADDAD, GHASSAN ELIAS Supervising Prescribing Practitioner Medical Doctor 113463 12/12/2023
GUSTAINYTE, VAIVA Supervising Prescribing Practitioner Osteopathic Physician 14612 12/12/2023
KIS, BELA Supervising Prescribing Practitioner Medical Doctor 113401 12/12/2023
KOCHARYAN, HAKOB Supervising Prescribing Practitioner Medical Doctor 157442 12/12/2023
NANDA, PAUL KALRA Supervising Dispensing Practitioner Medical Doctor 117861 10/13/2023
NANDA, PAUL KALRA Supervising Prescribing Practitioner Medical Doctor 117861 10/13/2023
PARIKH, NAINESH SHARAD Supervising Prescribing Practitioner Medical Doctor 128082 12/12/2023
SALLOUM, ELIAS HABIB Supervising Prescribing Practitioner Medical Doctor 143403 12/12/2023
VENKAT, SHREE RAMANAN DR Supervising Prescribing Practitioner Medical Doctor 116495 08/05/2024

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Name Relationship Profession License Effective Date

Click on the License Number to view License Details for that Practitioner

Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 11/23/2024



* 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.