License Verification

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KIMBERLY WAITE STACKPOLE

License Number: PA9108139

Data As Of 7/5/2025

Profession
Physician Assistant
License
PA9108139
License Status
Clear/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
08/27/2014
Address of Record
303 N CLYDE MORRIS BLVD
DAYTONA BEACH, FL 32114
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
1041 DUNLAWTON AVE. HALIFAX HEALTH
PORT ORANGE, FL 32127
Address
1340 RIDGEWOOD AVENUE
HOLLY HILL, FL 32117
Name Relationship Profession License Effective Date
BRAITHWAITE, RICHARD LEE Supervising Prescribing Practitioner Medical Doctor 90496 09/28/2017
SCHWARTZ, EDWARD BENJAMIN Supervising Prescribing Practitioner Osteopathic Physician 7981 09/28/2017

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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 7/5/2025



* 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.