License Verification

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SHAWN DESHANNON TAYLOR

License Number: PA9104301

Data As Of 11/21/2024

Profession
Physician Assistant
License
PA9104301
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
08/27/2007
Address of Record
906 PALM BLVD S
NICEVILLE URGENT CARE
NICEVILLE, FL 32578
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
2400-A S FERNDON BLVD. CRESTVIEW URGENT CARE
CRESTVIEW, FL 32536
Address
7800 US HIGHWAY 98 WEST SACRED HEART HOSPITAL EMERALD COAST EMERGENCY DEPARTMENT
MIRIMAR BEACH, FL 32550
Address
2190 Hwy 85 N Twin Cities Hospital Emergency Department
NICEVILLE, FL 32578
Name Relationship Profession License Effective Date
BERRY, SHANNON GAYLE Supervising Prescribing Practitioner Medical Doctor 152055 07/22/2024
BRADLEY, REBECCA Supervising Prescribing Practitioner Medical Doctor 147611 08/24/2024
DUERR, KARL MICHAEL Supervising Prescribing Practitioner Medical Doctor 151983 08/23/2024
HAMPTON, ZACHARY EDWARD Supervising Prescribing Practitioner Osteopathic Physician 18067 08/22/2024
HILL, JOHN PATRICK Supervising Prescribing Practitioner Medical Doctor 126139 06/15/2023
HWANG, CHARLES WILLIAM JR Supervising Prescribing Practitioner Medical Doctor 126436 08/12/2024
KOERTNER, ADAM Supervising Prescribing Practitioner Medical Doctor 157233 07/22/2024
LANG, JUERGEN Supervising Prescribing Practitioner Medical Doctor 164763 10/14/2024
LATHAM, JOSHUA LUKE DO Supervising Prescribing Practitioner Osteopathic Physician 10027 07/23/2024
MELANCON, ERIC EUGENE Supervising Prescribing Practitioner Medical Doctor 150172 08/22/2024
NOGGLE, TOMMY STEVEN MD Supervising Prescribing Practitioner Medical Doctor 93880 02/01/2018
RASIWALA, AZIMA Supervising Prescribing Practitioner Osteopathic Physician 18254 08/08/2024
RIZZUTO, WILLIAM THOMAS Supervising Prescribing Practitioner Medical Doctor 161389 09/09/2024
THOMPSON, TOMMY GLEN II Supervising Prescribing Practitioner Medical Doctor 128635 07/29/2024
WALKER, ROBERT KENNETH Supervising Prescribing Practitioner Medical Doctor 163903 08/23/2024
WESTBROOK, JAMES WESLEY Supervising Prescribing Practitioner Medical Doctor 146630 08/19/2024

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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 11/21/2024



* 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.