License Verification

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License Number: OS9230

Data As Of 11/21/2024

Profession
Osteopathic Physician
License
OS9230
License Status
CLEAR/Active
License Expiration Date
3/31/2026
License Original Issue Date
04/28/2004
Address of Record
ST JOSEPHS HOSPITAL SOUTH
6901 SIMMONS LOOP
RIVERVIEW, FL 33578
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
Yes - Click on Discipline/Admin Action tab to see more details
Public Complaint
Yes - Click on Discipline/Admin Action tab to see more details

No secondary locations found.


Name Relationship Profession License Effective Date
CHAN, ADDISON CHI-KIT Supervisor Osteopathic Physician 16884 06/03/2021
CHRISTIANO, DANIELLE MARIE Supervisor Medical Doctor 98327 05/25/2021
CRUZ, WANDA E Supervisor Osteopathic Physician 11330 05/21/2021
HOLT, TIMOTHY MARK Supervisor Osteopathic Physician 7964 05/14/2021

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Name Relationship Profession License Effective Date
BROWN, RICHARD Subordinate Medical Doctor 132286 6/10/2021
SHIMANDLE, THOM RICHARD Prescribing Physician Assistant Physician Assistant 9101577 10/30/2017

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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.