License Verification

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MARK NEIDHAMMER COSLOW

License Number: PA9104137

Data As Of 11/22/2024

Profession
Physician Assistant
License
PA9104137
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
04/12/2007
Address of Record
611 Zeigler Dr.
Putnam Community Medical Center
PALATKA, FL 32177
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
BALOGUN, MODINAT YETUNDE Supervising Prescribing Practitioner Osteopathic Physician 11666 09/06/2017
CROWLEY, SEAN CORNELIUS MD Supervising Prescribing Practitioner Medical Doctor 115516 09/06/2017
DEAKTER, DANIEL ROBERT Supervising Prescribing Practitioner Medical Doctor 32665 09/06/2017
GIBBONS, MICHAEL THOMAS MR Supervising Prescribing Practitioner Medical Doctor 101919 09/06/2017
MUCCI, DAVID ANTHONY Supervising Prescribing Practitioner Medical Doctor 127705 09/06/2017
OLIVER, WARREN A JR Supervising Prescribing Practitioner Osteopathic Physician 11743 09/06/2017
SBARRO, MARK JAMES Supervising Prescribing Practitioner Osteopathic Physician 8663 09/06/2017
SEMASHKO, DENISE CAROL Supervising Prescribing Practitioner Medical Doctor 94737 09/06/2017
WARD, AARON B Supervising Prescribing Practitioner Medical Doctor 128999 09/06/2017

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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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