License Verification

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KRISTOPHER SHANE HASENAUER

License Number: PA9108369

Data As Of 5/21/2024

Profession
Physician Assistant
License
PA9108369
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
10/28/2014
Address of Record
Emerald Medical LLC
6200 20th ST
STE 378
VERO BEACH, FL 32966
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
Emerald Medical LLC 501 NW University BLVD
PORT SAINT LUCIE, FL 34986
Name Relationship Profession License Effective Date
AGOSTO DIAZ, EDIL J Supervising Prescribing Practitioner Medical Doctor 102761 11/01/2022
BANAPOOR, BENJAMIN Supervising Prescribing Practitioner Medical Doctor 156442 10/25/2022
BROWN, MARTY RAY M D Supervising Prescribing Practitioner Medical Doctor 75648 10/25/2023
GILROY, RONALD THOMAS MD Supervising Prescribing Practitioner Medical Doctor 61905 11/01/2022
JOCKOVICH, MILAN MD Supervising Prescribing Practitioner Medical Doctor 65559 10/25/2022
PIRAZZI-MARQUEZ, BEATRIZ M Supervising Prescribing Practitioner Medical Doctor 102083 04/20/2023
REHAK, CHRISTOPHER STEPHEN Supervising Prescribing Practitioner Medical Doctor 78080 10/25/2022
ST CLAIR, AARON LEE Supervising Prescribing Practitioner Medical Doctor 106075 06/26/2023
VAZQUEZ, JOHNNY J Supervising Prescribing Practitioner Medical Doctor 97644 10/25/2022

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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 5/21/2024



* 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.


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