License Verification

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GINA MARIE BROCK

License Number: PA9102907

Data As Of 9/28/2024

Profession
Physician Assistant
License
PA9102907
License Status
DELINQUENT/
Qualifications
Prescribing
License Expiration Date
1/31/2024
License Original Issue Date
07/16/2004
Address of Record
2001 KINGSLEY AVENUE
ORANGE PARK, FL 32073
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
6477 103RD ST PARK WEST ER
JACKSONVILLE, FL 32210
Address
611 ZEAGLER DR. PUTNAM COMMUNITY MEDICAL CENTER
PALATKA, FL 32177
Name Relationship Profession License Effective Date
ALEMAN-BERMUDEZ, JAIME J Supervising Prescribing Practitioner Medical Doctor 49940 04/02/2018
ALONSO, LEONARDO LAZARO Supervising Prescribing Practitioner Osteopathic Physician 6584 04/02/2018
ATTLESEY, MARK GRAHAM Supervising Prescribing Practitioner Medical Doctor 71653 04/02/2018
BAKOR, NADIA Supervising Prescribing Practitioner Medical Doctor 131303 04/11/2018
CHAPMAN, JENNIFER COLES Supervising Prescribing Practitioner Medical Doctor 125751 04/02/2018
CHEANVECHAI, DAYCHA Supervising Prescribing Practitioner Medical Doctor 76415 04/02/2018
CURRIE, MICHAEL JOHN Supervising Prescribing Practitioner Osteopathic Physician 14738 04/11/2018
DAVIS, DAVID RICHARD Supervising Prescribing Practitioner Medical Doctor 96442 04/02/2018
EUWEMA, MICHAEL SCOTT Supervising Prescribing Practitioner Medical Doctor 91648 04/02/2018
HUMPHRIES, JERRY FRANKLIN JR Supervising Prescribing Practitioner Medical Doctor 112733 04/02/2018
JENKINS, FREDERICK LUCAS Supervising Prescribing Practitioner Medical Doctor 83245 04/02/2018
JOHNSON, JENNIFER BURKE Supervising Prescribing Practitioner Medical Doctor 115159 04/02/2018
KEENER, JANEL LAURA Supervising Prescribing Practitioner Medical Doctor 115434 04/02/2018
KING, FORREST JOSEPH Supervising Prescribing Practitioner Medical Doctor 124146 04/02/2018
KOURY, RONALD FORREST D O Supervising Prescribing Practitioner Osteopathic Physician 8090 04/02/2018
MATHAI, ALEX Supervising Prescribing Practitioner Medical Doctor 122229 04/11/2018
MENZE, ROGER MICHEEL Supervising Prescribing Practitioner Medical Doctor 68199 04/02/2018
OLIVER, RADAMES ALBERTO Supervising Prescribing Practitioner Medical Doctor 67906 04/02/2018
PAPAVASILIOU, JOHN JOSEPH Supervising Prescribing Practitioner Medical Doctor 66371 04/02/2018
QUADER, MOHAMMED AZIZUL Supervising Prescribing Practitioner Medical Doctor 91402 04/02/2018
WARD, JILL ANGELA Supervising Prescribing Practitioner Medical Doctor 110689 04/02/2018
WHEELER, MARERIL Supervising Prescribing Practitioner Medical Doctor 126534 04/02/2018
WINNINGHAM, DAVID JASON Supervising Prescribing Practitioner Osteopathic Physician 12586 04/02/2018
ZERNIAL, CHRISTOPHER B Supervising Prescribing Practitioner Medical Doctor 131593 04/11/2018

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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 9/28/2024



* 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.