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GWENDOLYN BRUCH MICHAELMAN

License Number: PA9104166

Data As Of 11/22/2024

Profession
Physician Assistant
License
PA9104166
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
05/29/2007
Address of Record
2627 West Eau GaiUe Blvd.
Suite 101
MELBOURNE, FL 32935
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
1425 MALABAR RD. N.E. PALM BAY HOSPITAL
PALM BAY, FL 32907
Address
8745 N Wickham Road Viera Hospital
MELBOURNE, FL 32940
Address
701 W Cocoa Beach Causeway Cape Canaveral
COCOA BEACH, FL 32931
Name Relationship Profession License Effective Date
AGOSTO DIAZ, EDIL J Supervising Prescribing Practitioner Medical Doctor 102761 11/01/2022
BANAPOOR, BENJAMIN Supervising Prescribing Practitioner Medical Doctor 156442 10/25/2022
BRONSTEMA, CLARENCE JAMES DO Supervising Prescribing Practitioner Osteopathic Physician 9722 10/25/2022
BROWN, MARTY RAY M D Supervising Prescribing Practitioner Medical Doctor 75648 10/25/2022
DEVAUX, MIKAELA ELISE Supervising Prescribing Practitioner Medical Doctor 130853 06/16/2021
DEVEREAUX, DANIELLE Supervising Prescribing Practitioner Medical Doctor 129224 05/17/2017
FOSTER, QUINTON ADAM Supervising Prescribing Practitioner Medical Doctor 168147 08/14/2024
GAGEN, JAMES SHAWN Supervising Prescribing Practitioner Osteopathic Physician 10263 10/25/2022
HEIST, DORAN ROBERT MD Supervising Prescribing Practitioner Medical Doctor 111822 06/16/2021
HOMERICK, MICHAEL JOHN Supervising Prescribing Practitioner Medical Doctor 119113 09/15/2016
JOCKOVICH, MILAN MD Supervising Prescribing Practitioner Medical Doctor 65559 10/25/2022
JONES JR, PRESTON M Supervising Prescribing Practitioner Medical Doctor 162801 08/17/2023
MATHEW, DANA RICHARDS MD Supervising Prescribing Practitioner Medical Doctor 128175 09/15/2016
MCGOOHAN, MICHAEL PATRICK DO Supervising Prescribing Practitioner Osteopathic Physician 6325 06/16/2021
PIRAZZI-MARQUEZ, BEATRIZ M Supervising Prescribing Practitioner Medical Doctor 102083 04/20/2023
ROTOLO, ALYSSA BIXBY Supervising Prescribing Practitioner Medical Doctor 127035 04/03/2019
ST CLAIR, AARON LEE Supervising Prescribing Practitioner Medical Doctor 106075 06/26/2023
TYMKOWICZ, ALEXANDRIA Supervising Prescribing Practitioner Medical Doctor 156308 03/14/2023
VAZQUEZ, JOHNNY J Supervising Prescribing Practitioner Medical Doctor 97644 11/28/2022
WEBER, DOUGLAS ANTHONY Supervising Prescribing Practitioner Medical Doctor 143900 06/28/2020
WEEMAN, MITCHELL Supervising Prescribing Practitioner Medical Doctor 160791 07/26/2023

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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.