License Verification

Printer Friendly Version

STEVEN GREGORY WALLACE JR.

License Number: PA9107761

Data As Of 12/22/2024

Profession
Physician Assistant
License
PA9107761
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
01/09/2014
Address of Record
1324 Lakeland Hill Blvd
Lakeland Regional Health Medical Center
Emergency Department
LAKELAND, FL 33805
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
ABRAHAMSEN, NADIA Supervising Prescribing Practitioner Medical Doctor 108847 02/28/2018
AKKASHIAN, MICHAEL BERNARD Supervising Prescribing Practitioner Medical Doctor 113464 09/19/2017
ALFONSO, ADALBERTO JR Supervising Prescribing Practitioner Medical Doctor 122516 09/19/2017
AMATEA, JOHN M Supervising Prescribing Practitioner Medical Doctor 111903 09/19/2017
ANCHETA, JOEY SALDANA MD Supervising Prescribing Practitioner Medical Doctor 72598 09/19/2017
AREGOOD, JENNIFER JOY Supervising Prescribing Practitioner Medical Doctor 116318 09/19/2017
ARREDONDO, COREY CUMBIE Supervising Prescribing Practitioner Medical Doctor 85016 09/19/2017
BARBERA, ANDREW ROBERT Supervising Prescribing Practitioner Medical Doctor 144387 10/01/2020
BEACH, KEVIN RICHARD Supervising Prescribing Practitioner Medical Doctor 107000 09/19/2017
BHISITKUL, DONNA MARIE Supervising Prescribing Practitioner Medical Doctor 70258 09/19/2017
BLIND, FRED JOSEPH Supervising Prescribing Practitioner Medical Doctor 99282 09/19/2017
BRAR, SARDUL SINGH MD Supervising Prescribing Practitioner Medical Doctor 48371 09/19/2017
BRENNER, ANNETTE MAGNANT Supervising Prescribing Practitioner Medical Doctor 70818 02/06/2020
BROWN, RICHARD Supervising Prescribing Practitioner Medical Doctor 132286 09/19/2017
BUTZ, ABRAHAM F Supervising Prescribing Practitioner Medical Doctor 102668 09/19/2017
CARMAN, MATTHEW WILLIAM Supervising Prescribing Practitioner Medical Doctor 99548 09/19/2017
CAUSEY, ALAN LANE Supervising Prescribing Practitioner Medical Doctor 70284 09/19/2017
CHUNG, CHARLES R Supervising Prescribing Practitioner Medical Doctor 99441 09/19/2017
COKER, PHILLIP RYAN Supervising Prescribing Practitioner Medical Doctor 122260 09/19/2017
COVITZ, SHANNON MIXON Supervising Prescribing Practitioner Osteopathic Physician 11652 02/06/2020
DE LOS SANTOS, JESSE Supervising Prescribing Practitioner Medical Doctor 112913 09/19/2017
DELEON, JASON Supervising Prescribing Practitioner Medical Doctor 122537 02/12/2019
DUBEY, JESSE VINCENT Supervising Prescribing Practitioner Osteopathic Physician 13099 09/19/2018
ESCOWITZ, HAL ETHAN Supervising Prescribing Practitioner Medical Doctor 81690 09/19/2017
FAWSETT, CHARLES ROBINSON II Supervising Prescribing Practitioner Medical Doctor 112904 09/19/2017
FISHER, ROSE MARIE Supervising Prescribing Practitioner Osteopathic Physician 6698 09/19/2017
GILLESPIE, RITA MARGARET MARY Supervising Prescribing Practitioner Osteopathic Physician 13077 02/12/2019
GUGGINO, STEVEN ANTHONY MD Supervising Prescribing Practitioner Medical Doctor 83061 09/19/2017
HABER, TODD SETH Supervising Prescribing Practitioner Medical Doctor 57935 09/19/2017
HANEY, MARISA LIANA Supervising Prescribing Practitioner Medical Doctor 106073 09/19/2017
HEAD, BRIAN CHRISTOPHER Supervising Prescribing Practitioner Medical Doctor 122748 09/19/2017
JOHN, TESHY VARUGHESE Supervising Prescribing Practitioner Medical Doctor 125364 01/11/2019
KARP, JULIANA Supervising Prescribing Practitioner Medical Doctor 64823 09/19/2017
LASSETER, MEGAN LEIGH MD Supervising Prescribing Practitioner Medical Doctor 109910 09/19/2017
LINDENBLAD, ERIC HAMILTON Supervising Prescribing Practitioner Medical Doctor 43429 09/19/2017
LONGO, JENNIFER ANN Supervising Prescribing Practitioner Medical Doctor 113332 11/12/2019
MARICHAL, JOSE L MD Supervising Prescribing Practitioner Medical Doctor 21830 09/19/2017
MCFARLAND, MICHAEL SCOTT Supervising Prescribing Practitioner Medical Doctor 99023 09/19/2017
MCGLINN, SEAN PATRICK D O Supervising Prescribing Practitioner Osteopathic Physician 9846 09/19/2017
MCKEE, KRISTIN CORY Supervising Prescribing Practitioner Osteopathic Physician 12083 09/19/2017
MELTON, JAMES DAVID III Supervising Prescribing Practitioner Medical Doctor 52100 09/19/2017
MEMON, SUMERA HAROON Supervising Prescribing Practitioner Osteopathic Physician 11668 08/20/2018
MISDARY, JOHN SARATIAL MD Supervising Prescribing Practitioner Medical Doctor 111957 03/28/2018
OLDANO, KAREN THOMAS Supervising Prescribing Practitioner Osteopathic Physician 6570 09/19/2017
OLSON, CHRISTOPHER EARL Supervising Prescribing Practitioner Medical Doctor 91253 09/19/2017
PALIGA, ANDREW Supervising Prescribing Practitioner Medical Doctor 111562 05/06/2019
PATEL, TEJAS Supervising Prescribing Practitioner Osteopathic Physician 13790 05/06/2019
PAYOR, AUSTIN DANIEL Supervising Prescribing Practitioner Osteopathic Physician 10925 03/04/2020
REDDEN, DANYELLE ANN Supervising Prescribing Practitioner Medical Doctor 110215 09/19/2017
REEBER, CLIFF BENJAMIN Supervising Prescribing Practitioner Medical Doctor 73869 09/19/2017
REGAN, TIMOTHY JOHN Supervising Prescribing Practitioner Medical Doctor 94162 09/19/2017
REINHARDT, NEIL CHRISTOPHER Supervising Prescribing Practitioner Medical Doctor 69496 11/12/2019
RHODES, DAVID JOSEPH Supervising Prescribing Practitioner Medical Doctor 106826 09/19/2017
RODGERS, CHRISTOPHER NEILTON MD Supervising Prescribing Practitioner Medical Doctor 99231 09/19/2017
RODRIGUEZ, VASHUN APONTE Supervising Prescribing Practitioner Medical Doctor 104068 09/19/2017
ROLA, ALEXANDER Supervising Prescribing Practitioner Osteopathic Physician 8833 09/19/2017
SALAZAR, MANUEL MAURICIO Supervising Prescribing Practitioner Medical Doctor 36859 09/19/2017
SANTIAGO, RAFAEL Supervising Prescribing Practitioner Medical Doctor 90335 09/19/2017
SCHILLINGER, MATTHEW Supervising Prescribing Practitioner Osteopathic Physician 9191 09/19/2017
SMITH, DAVID JAMES Supervising Prescribing Practitioner Osteopathic Physician 9167 09/19/2017
SPENCER, ANDREW JOSEPH Supervising Prescribing Practitioner Medical Doctor 122767 05/06/2019
SUEN, ANDREA CATHERINE Supervising Prescribing Practitioner Medical Doctor 116964 01/11/2019
TICKETT, SHELLEY SMITH Supervising Prescribing Practitioner Medical Doctor 90313 02/28/2018
VISRAM, FARID NIZARALI Supervising Prescribing Practitioner Medical Doctor 95308 09/19/2017
VU, CHRISTOPHER HUY Supervising Prescribing Practitioner Medical Doctor 109654 09/19/2017
VYTYKAC, ADAM Supervising Prescribing Practitioner Medical Doctor 115497 08/20/2018
WAN, ERIC KUO HSUAN Supervising Prescribing Practitioner Medical Doctor 92490 09/19/2017
WEBSTER, MAUREEN MICHELLE Supervising Prescribing Practitioner Medical Doctor 76488 09/19/2017
WEEKS, SCOTT ROBERT Supervising Prescribing Practitioner Osteopathic Physician 8388 09/19/2017
WISER, ROBERT K Supervising Prescribing Practitioner Medical Doctor 139864 02/06/2020
YICK, ANDREW VAN Supervising Prescribing Practitioner Medical Doctor 109669 09/19/2017
ZACHARIAH, ANISH BABU M D Supervising Prescribing Practitioner Medical Doctor 101413 11/12/2019
ZAHN, ELISE JOY Supervising Prescribing Practitioner Osteopathic Physician 7897 09/19/2017

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

Name Relationship Profession License Effective Date
BARNES, MICHAEL WILLIAM Prescribing Physician Assistant Physician Assistant 9102604 6/28/2023
INJETY, SHYAM KUMAR RAJENDRA Prescribing Physician Assistant Physician Assistant 9108987 6/28/2023
MCNALLY, MELISSA LEE Prescribing Physician Assistant Physician Assistant 9102840 6/28/2023
SCOTT, RANDALL EUGENE Prescribing Physician Assistant Physician Assistant 9103913 6/28/2023
SKIDMORE, JUSTIN STUART Prescribing Physician Assistant Physician Assistant 9110082 6/28/2023

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 12/22/2024



* 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.