License Verification

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DIANA HERTEL WALTER

License Number: PA9102544

Data As Of 11/22/2024

Profession
Physician Assistant
License
PA9102544
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
08/29/2003
Address of Record
BayCare Medical Group
455 Pinellas Street
Suite 320
CLEARWATER, FL 33756
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
1200 7th Avenue North St. Anthony's Hospital
SAINT PETERSBURG, FL 33705
Address
300 Pinellas Street Morton Plant Hospital
CLEARWATER, FL 33756
Name Relationship Profession License Effective Date
BOTT, JEFFREY NORMAN Supervising Prescribing Practitioner Medical Doctor 73514 06/29/2020
HERIC, BLAINE RICHARD MD Supervising Prescribing Practitioner Medical Doctor 73348 03/11/2020
KAYATTA, MICHAEL OWEN MD Supervising Prescribing Practitioner Medical Doctor 136589 03/11/2020
OFENLOCH, JOHN CHARLES Supervising Prescribing Practitioner Medical Doctor 85019 03/11/2020
ROVIN, JOSHUA DAVID Supervising Prescribing Practitioner Medical Doctor 93801 03/11/2020

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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 11/22/2024



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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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