License Verification

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PAUL MICHAEL LEE GRENELLE

License Number: PA9105871

Data As Of 11/21/2024

Profession
Physician Assistant
License
PA9105871
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
01/10/2011
Address of Record
301 MEMORIAL MEDICAL PARKWAY
FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER
DAYTONA BEACH, FL 32117
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
60 MEMORIAL MEDICAL PKWY. FLORIDA HOSPITAL FLAGLER
PALM COAST, FL 32164
Name Relationship Profession License Effective Date
LIVINGSTON, ROBERT TERENCE Supervising Prescribing Practitioner Medical Doctor 83159 12/06/2016
MCNAMEE, JUSTIN JAMES Supervising Prescribing Practitioner Osteopathic Physician 12888 12/06/2016
MOSES, DUSTY ALLEN DR Supervising Prescribing Practitioner Medical Doctor 115932 12/06/2016
MUCCIOLO, PAUL MD Supervising Prescribing Practitioner Medical Doctor 69281 12/06/2016
RAMIA, MICHELLE MARIE Supervising Prescribing Practitioner Medical Doctor 116871 12/06/2016
SISKO, MATTHEW DAVID Supervising Prescribing Practitioner Medical Doctor 111919 12/06/2016
WEINER, TRACY I DO Supervising Prescribing Practitioner Osteopathic Physician 7471 12/06/2016

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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.


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