License Verification

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License Number: PA9104426

Data As Of 11/21/2024

Profession
Physician Assistant
License
PA9104426
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
11/08/2007
Address of Record
6101 Pine RIdge Rd
NAPLES, FL 34119
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
8300 COLLIER BLVD. PHYSICIANS REGIONA MEDICAL CENTER
NAPLES, FL 34114
Address
6101 PINE RIDGE ROAD PHYSICIANS REGIONAL MEDICAL CENTER
NAPLES, FL 34119
Address
2351 AARON ST MILLENIUM PHYSICIAN GROUP, LLC
PORT CHARLOTTE, FL 33952
Address
1735 SW Health Parkway
NAPLES, FL 34109
Name Relationship Profession License Effective Date
GOODHUE, BRIAN Supervising Prescribing Practitioner Osteopathic Physician 16414 11/19/2024
KIMM, JEFFREY Supervising Prescribing Practitioner Medical Doctor 145181 10/19/2024
LAMOUR, DANIELLA Supervising Prescribing Practitioner Osteopathic Physician 19702 09/06/2024
SIMPSON, DAMION Supervising Prescribing Practitioner Medical Doctor 162140 09/05/2024

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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 11/22/2024



* 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.