License Verification

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BROOKE MICHELLE PERUSSINA

License Number: PA9102180

Data As Of 11/22/2024

Profession
Physician Assistant
License
PA9102180
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
09/17/2002
Address of Record
130 Health Park Blvd
Flagler Family Medicine, PA
ST AUGUSTINE, FL 32086
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
28 Old Kings Road Suite A Flagler Family Medicine
PALM COAST, FL 32137
Address
315 West Town Place Unit 1 Flagler Family Medicine
ST AUGUSTINE, FL 32092
Address
130 Health Park Blvd Flagler Family Medicine A1A S Unit 101 & 102
ST AUGUSTINE, FL 32086
Address
6277 A1A S Imot 101 & 102 Flagler Family Medicine A1A S Unit 101 & 102
ST AUGUSTINE, FL 32080
Address
105 South Park Blvd Flagler Family Medicine Unit C302
ORLANDO, FL 32806
Name Relationship Profession License Effective Date
ASHDJI, RESWAN ROSA Supervising Prescribing Practitioner Medical Doctor 57416 12/16/2021
DONOFRIO, DANIEL JOSEPH MD Supervising Prescribing Practitioner Medical Doctor 106486 10/22/2020
MORALES GERALDINO, GARY ENRIQUE Supervising Prescribing Practitioner Medical Doctor 122090 03/07/2022
SAVAGE, ROSEMARY A Supervising Prescribing Practitioner Osteopathic Physician 16806 05/14/2024

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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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