License Verification

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TANISHA MONIQUE HENRY

License Number: PA9103457

Data As Of 11/22/2024

Profession
Physician Assistant
License
PA9103457
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
09/13/2005
Address of Record
7259 S. Bingham Jct. Blvd
MIDVALE, UT 84047
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date
CZERNIECKI, BRIAN JOSEPH Supervising Prescribing Practitioner Medical Doctor 129379 11/04/2021
KILUK, JOHN VINCENT Supervising Prescribing Practitioner Medical Doctor 98964 11/04/2021
LARONGA, CHRISTINE Supervising Prescribing Practitioner Medical Doctor 93499 11/04/2021
LEE, MARIE CATHERINE Supervising Prescribing Practitioner Medical Doctor 99730 11/04/2021

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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.


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.