License Verification

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ALLISON BLAIR BLUNDEN

License Number: PA9104815

Data As Of 6/25/2024

Profession
Physician Assistant
License
PA9104815
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
10/01/2008
Address of Record
11715 RANGELAND PARKWAY
INTERCOASTAL MEDICAL GROUP INC.
BRADENTON, FL 34211
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
BENTZE, MICHAEL JAMES D O Supervising Prescribing Practitioner Osteopathic Physician 9174 03/24/2023
KASSOVER, JESSICA HENDRICK Supervising Prescribing Practitioner Osteopathic Physician 17699 06/20/2023
THACKER, ALEXANDER LEE Supervising Prescribing Practitioner Medical Doctor 119802 06/20/2023
VIGIL, JUAN CARLOS Supervising Prescribing Practitioner Osteopathic Physician 14510 08/14/2023

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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 6/25/2024



* 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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