License Verification

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JENNIFER LYNN MATEY

License Number: PA9108982

Data As Of 5/21/2024

Profession
Physician Assistant
License
PA9108982
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
09/03/2015
Address of Record
2627 West Eau Gallie Blvd.
Suite 101
MELBOURNE, FL 32935
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
Yes
Discipline on File
No
Public Complaint
No
Address
301 MEMORIAL MEDICAL PARKWAY
DAYTONA BEACH, FL 32117
Address
1055 Saxon Blvd Advent Health Fish Memorial
ORANGE CITY, FL 32763
Address
60 Memorial Medical Pkwy Palm Coast
PALM COAST, FL 32164
Address
401 Palmetto Street Advent Health New Smyrna
NEW SMYRNA BEACH, FL 32168
Address
701 W Plymouth Avenue Advent Health Deland
ORMOND BEACH, FL 32174
Address
1425 Malabar Rd
PALM BAY, FL 32907
Name Relationship Profession License Effective Date
AGOSTO DIAZ, EDIL J Supervising Prescribing Practitioner Medical Doctor 102761 08/31/2023
ALVAREZ, COREY Supervising Prescribing Practitioner Medical Doctor 131625 08/31/2023
BANAPOOR, BENJAMIN Supervising Prescribing Practitioner Medical Doctor 156442 08/31/2023
BEATTY, ROBERT PATRICK Supervising Prescribing Practitioner Medical Doctor 97579 08/31/2023
BRONSTEMA, CLARENCE JAMES DO Supervising Prescribing Practitioner Osteopathic Physician 9722 08/31/2023
BROWN, MARTY RAY M D Supervising Prescribing Practitioner Medical Doctor 75648 08/31/2023
CHAO, MAURICE JAY Supervising Prescribing Practitioner Osteopathic Physician 8629 08/31/2023
CHESLOCK, TIMOTHY JOHN Supervising Prescribing Practitioner Osteopathic Physician 12099 08/31/2023
CROSS, WILLIAM IAN Supervising Prescribing Practitioner Osteopathic Physician 10316 08/31/2023
CSORTAN, ERIC STEVEN Supervising Prescribing Practitioner Medical Doctor 84708 08/31/2023
DEVAUX, MIKAELA ELISE Supervising Prescribing Practitioner Medical Doctor 130853 08/31/2023
DEVEREAUX, DANIELLE Supervising Prescribing Practitioner Medical Doctor 129224 08/31/2023
D'ONOFRIO, KALI RAE Supervising Prescribing Practitioner Osteopathic Physician 12738 08/31/2023
DUCKWORTH, ANGELA LEEANN MD Supervising Prescribing Practitioner Medical Doctor 112929 08/31/2023
DUDLEY, LARISSA SOPHIA Supervising Prescribing Practitioner Medical Doctor 131434 08/31/2023
FLEMING, MICHAEL MD Supervising Prescribing Practitioner Medical Doctor 133576 08/31/2023
GAGEN, JAMES SHAWN Supervising Prescribing Practitioner Osteopathic Physician 10263 08/31/2023
GREEN, DOUGLAS WARREN MD Supervising Prescribing Practitioner Medical Doctor 81481 08/31/2023
GUTTA, RAJESH Supervising Prescribing Practitioner Medical Doctor 82886 08/31/2023
HEIST, DORAN ROBERT MD Supervising Prescribing Practitioner Medical Doctor 111822 08/31/2023
HOMERICK, MICHAEL JOHN Supervising Prescribing Practitioner Medical Doctor 119113 08/31/2023
JOCKOVICH, MILAN MD Supervising Prescribing Practitioner Medical Doctor 65559 08/31/2023
JONES, PRESTON MICHAEL MD Supervising Prescribing Practitioner Medical Doctor 51045 08/31/2023
LENOCI, ROBERT Supervising Prescribing Practitioner Medical Doctor 156047 08/31/2023
LIVINGSTON, ROBERT TERENCE Supervising Prescribing Practitioner Medical Doctor 83159 06/03/2021
LLINAS, JACQUELINE B MD Supervising Prescribing Practitioner Medical Doctor 68727 08/31/2023
MATHEW, DANA RICHARDS MD Supervising Prescribing Practitioner Medical Doctor 128175 08/31/2023
MAULDIN, JUSTIN ANTHONY Supervising Prescribing Practitioner Medical Doctor 131802 08/31/2023
MCNAMEE, JUSTIN JAMES Supervising Prescribing Practitioner Osteopathic Physician 12888 06/01/2021
MILES, JAMES TIMOTHY Supervising Prescribing Practitioner Medical Doctor 76017 08/31/2023
MISHOCK, KEVIN ALLAN Supervising Prescribing Practitioner Osteopathic Physician 18411 08/31/2023
MONTGOMERY, ELISHA ANNE Supervising Prescribing Practitioner Medical Doctor 122062 08/31/2023
MOSES, DUSTY ALLEN DR Supervising Prescribing Practitioner Medical Doctor 115932 06/01/2021
MUCCIOLO, PAUL MD Supervising Prescribing Practitioner Medical Doctor 69281 06/03/2012
OBEID, DANY ALI Supervising Prescribing Practitioner Medical Doctor 97780 03/23/2017
OLIVEIRA, BRIAN MARIO Supervising Prescribing Practitioner Medical Doctor 110586 08/31/2023
OSWALD, NED ANTHONY MD Supervising Prescribing Practitioner Medical Doctor 121076 08/31/2023
PIRAZZI-MARQUEZ, BEATRIZ M Supervising Prescribing Practitioner Medical Doctor 102083 08/31/2023
RAMIA, MICHELLE MARIE Supervising Prescribing Practitioner Medical Doctor 116871 06/01/2021
REHAK, CHRISTOPHER STEPHEN Supervising Prescribing Practitioner Medical Doctor 78080 08/31/2023
ROTOLO, ALYSSA BIXBY Supervising Prescribing Practitioner Medical Doctor 127035 08/31/2023
SISKO, MATTHEW DAVID Supervising Prescribing Practitioner Medical Doctor 111919 06/04/2021
ST CLAIR, AARON LEE Supervising Prescribing Practitioner Medical Doctor 106075 08/31/2023
STOJANOVSKI, MIHAIL METODIJA Supervising Prescribing Practitioner Medical Doctor 130869 08/31/2023
TAIVAL, BRANDON JEAN DO Supervising Prescribing Practitioner Osteopathic Physician 9481 08/31/2023
TYMKOWICZ, ALEXANDRIA Supervising Prescribing Practitioner Medical Doctor 156308 08/31/2023
VAZQUEZ, JOHNNY J Supervising Prescribing Practitioner Medical Doctor 97644 08/31/2023
WALKER, GEORGE HAROLD MD Supervising Prescribing Practitioner Medical Doctor 70189 08/31/2023
WEBER, DOUGLAS ANTHONY Supervising Prescribing Practitioner Medical Doctor 143900 08/31/2023
WEINER, TRACY I DO Supervising Prescribing Practitioner Osteopathic Physician 7471 06/04/2021
YOUNG, VICTOR CHANCE Supervising Prescribing Practitioner Osteopathic Physician 8339 08/31/2023

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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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