License Verification

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License Number: ME78546

Data As Of 9/28/2024

Profession
Medical Doctor
License
ME78546
License Status
CLEAR/Active
Qualifications
Dispensing Practitioner
License Expiration Date
1/31/2025
License Original Issue Date
07/16/1999
Address of Record
500 WINDERLEY PLACE, Suite 115
SUITE 115
MAITLAND, FL 32751
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
7727 Lake Underhill Road
ORLANDO, FL 32822
Name Relationship Profession License Effective Date

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Name Relationship Profession License Effective Date
BURCHENSON, KRYSTA-GAYE LATOYA Prescribing Physician Assistant Physician Assistant 9108009 3/27/2018
CARMONA, DIEGO ENRIQUE Prescribing Physician Assistant Physician Assistant 9106216 9/8/2023
DAVIS, MARC DALE Prescribing Physician Assistant Physician Assistant 9102789 9/8/2023
DORESTANT, STEPHANIE Prescribing Physician Assistant Physician Assistant 9118255 2/22/2024
FRITZ, HILARY Prescribing Physician Assistant Physician Assistant 9110830 6/30/2024
GRAHAM, KELLY ANN Prescribing Physician Assistant Physician Assistant 9112573 10/24/2019
HABIB, LAILA NICOLE Prescribing Physician Assistant Physician Assistant 9111509 12/17/2018
HOLLINGSWORTH, BRIEN Prescribing Physician Assistant Physician Assistant 9117026 2/27/2023
LASS, JORDAN LANE Prescribing Physician Assistant Physician Assistant 9118385 2/22/2024
LUKASIK, MICHELLE NICOLE Prescribing Physician Assistant Physician Assistant 9111603 12/19/2018
MACKENZIE, WILLIAM CARL Prescribing Physician Assistant Physician Assistant 9112545 10/9/2019
MARCHIOLI, MARC EDWARD Prescribing Physician Assistant Physician Assistant 9106961 3/2/2023
MEDICI, BROOK Prescribing Physician Assistant Physician Assistant 9115836 10/20/2023
PATEL, POOJA CHANDRAKANT Prescribing Physician Assistant Physician Assistant 9117635 9/8/2023
WINCHESTER, LIAM JAY Prescribing Physician Assistant Physician Assistant 9117745 2/22/2024

Click on the License Number to view License Details for that Practitioner

Name Relationship Profession License Effective Date

Click on the License Number to view License Details for that Practitioner



No Continuing Education Hours Received from Approved Providers As Of 9/28/2024



* 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.