License Verification

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JONATHAN FAIN BULLMAN

License Number: PA9107709

Data As Of 12/22/2024

Profession
Physician Assistant
License
PA9107709
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
12/10/2013
Address of Record
Santa Rosa Medical Center
6002 Berryhill Road
MILTON, FL 32570
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
North Okaloosa Medical Center 151 East Redstone Avenue
CRESTVIEW, FL 32539
Name Relationship Profession License Effective Date
ALLMAN, JEFFREY WILLIAM Supervising Prescribing Practitioner Osteopathic Physician 9007 07/19/2023
BERRY, SHANNON GAYLE Supervising Prescribing Practitioner Medical Doctor 152055 06/17/2021
BRADLEY, REBECCA Supervising Prescribing Practitioner Medical Doctor 147611 01/10/2024
CRINER, ROGER D JR Supervising Prescribing Practitioner Medical Doctor 114331 06/21/2021
CUPO, WILLIAM WALTER MD Supervising Prescribing Practitioner Medical Doctor 86389 09/16/2022
DUERR, KARL MICHAEL Supervising Prescribing Practitioner Medical Doctor 151983 05/31/2021
EDLER, RAYME MICHELLE Supervising Prescribing Practitioner Medical Doctor 109913 09/09/2021
GEORGE, MATTHEW Supervising Prescribing Practitioner Medical Doctor 164808 10/12/2023
HAMPTON, ZACHARY EDWARD Supervising Prescribing Practitioner Osteopathic Physician 18067 07/13/2023
HARVEY, KYLE Supervising Prescribing Practitioner Medical Doctor 158195 07/25/2023
HILL, ROBERT LEE Supervising Prescribing Practitioner Medical Doctor 166795 08/26/2024
HWANG, CHARLES WILLIAM JR Supervising Prescribing Practitioner Medical Doctor 126436 07/25/2023
KOERTNER, ADAM Supervising Prescribing Practitioner Medical Doctor 157233 08/16/2023
LANG, JUERGEN Supervising Prescribing Practitioner Medical Doctor 164763 10/14/2024
LATHAM, JOSHUA LUKE DO Supervising Prescribing Practitioner Osteopathic Physician 10027 07/09/2021
LITTMAN, NICHOLAS Supervising Prescribing Practitioner Medical Doctor 151791 10/11/2022
MATTEUZZI, KATIE LOU Supervising Prescribing Practitioner Osteopathic Physician 19359 02/13/2024
MCNEIL, MEGAN IONE Supervising Prescribing Practitioner Medical Doctor 129689 05/02/2021
MEIS, DANIEL ROBERT Supervising Prescribing Practitioner Osteopathic Physician 19686 07/13/2023
MELANCON, ERIC EUGENE Supervising Prescribing Practitioner Medical Doctor 150172 07/02/2021
MULLIS, BARON THAXTON Supervising Prescribing Practitioner Medical Doctor 113789 02/02/2021
NOGGLE, TOMMY STEVEN MD Supervising Prescribing Practitioner Medical Doctor 93880 07/02/2021
NUCHERENO, ANTHONY RICHARD Supervising Prescribing Practitioner Osteopathic Physician 17869 07/26/2023
OWEN, STEPHANIE LEANN Supervising Prescribing Practitioner Medical Doctor 127333 07/09/2021
PATEL, JAIMIN BALWANT M D Supervising Prescribing Practitioner Medical Doctor 104797 09/22/2023
PATRONIS ADAMS, MARIA Supervising Prescribing Practitioner Physician Assistant 9111206 07/02/2021
RASIWALA, AZIMA Supervising Prescribing Practitioner Osteopathic Physician 18254 01/03/2021
RIZZUTO, WILLIAM THOMAS Supervising Prescribing Practitioner Medical Doctor 161389 07/25/2023
RUTH, ROBERT ALLAN Supervising Prescribing Practitioner Medical Doctor 74008 07/25/2023
SHEA, JILL MARIE Supervising Prescribing Practitioner Medical Doctor 136840 07/21/2023
THOMPSON, TOMMY GLEN II Supervising Prescribing Practitioner Medical Doctor 128635 07/09/2021
WALKER, ROBERT KENNETH Supervising Prescribing Practitioner Medical Doctor 163903 07/26/2023
WEST, KERRI ELESE Supervising Prescribing Practitioner Osteopathic Physician 18404 10/20/2021
WESTBROOK, JAMES WESLEY Supervising Prescribing Practitioner Medical Doctor 146630 07/09/2021

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Name Relationship Profession License Effective Date
SIMMONS, LEONARD WILLIAM Prescribing Physician Assistant Physician Assistant 9103209 7/29/2021

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Name Relationship Profession License Effective Date

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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.