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RICHARD PETERKIN WALLACE

License Number: ME85690

Data As Of 11/22/2024

Profession
Medical Doctor
License
ME85690
License Status
CLEAR/Active
Qualifications
Dispensing Practitioner
License Expiration Date
1/31/2025
License Original Issue Date
08/08/2002
Address of Record
1001 S. FT. HARRISON AVE.
SUITE 101
CLEARWATER, FL 33756
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

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

Name Relationship Profession License Effective Date
ANIELLO, KORINA Dispensing Physician Assistant Physician Assistant 9111950 8/13/2019
ANIELLO, KORINA Prescribing Physician Assistant Physician Assistant 9111950 8/13/2019
AYRAL, ERICA Prescribing Physician Assistant Physician Assistant 9110977 3/9/2018
BILITSKI, MARIJO Dispensing Physician Assistant Physician Assistant 9114430 7/17/2023
BILITSKI, MARIJO Prescribing Physician Assistant Physician Assistant 9114430 7/17/2023
CARSON, MICHAELA BROOKE Prescribing Physician Assistant Physician Assistant 9117511 6/19/2023
EXPOSITO NODARSE, MARIAM Dispensing Physician Assistant Physician Assistant 9116120 7/17/2023
LY, KEVIN Dispensing Physician Assistant Physician Assistant 9112466 12/10/2019
LY, KEVIN Prescribing Physician Assistant Physician Assistant 9112466 12/6/2019
MACK, SEAN Dispensing Physician Assistant Physician Assistant 9115105 6/21/2022
MACK, SEAN Prescribing Physician Assistant Physician Assistant 9115105 6/21/2022
NICHOLSON, DANIELLE Dispensing Physician Assistant Physician Assistant 9112675 12/10/2019
NICHOLSON, DANIELLE Prescribing Physician Assistant Physician Assistant 9112675 12/10/2019
NORDSTROM, ERIC CONRAD Dispensing Physician Assistant Physician Assistant 9115968 7/5/2022
STURDIVANT, MARIA PAIGE Dispensing Physician Assistant Physician Assistant 9116749 2/24/2023
STURDIVANT, MARIA PAIGE Prescribing Physician Assistant Physician Assistant 9116749 2/24/2023

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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 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.