License Verification

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MICHAEL DAVID TALHOUK

License Number: PA9109253

Data As Of 12/22/2024

Profession
Physician Assistant
License
PA9109253
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
12/15/2015
Address of Record
2502 W St. Isabel St.
Suite B
TAMPA, FL 33607
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
4211 VanDyke Road
LUTZ, FL 33558
Address
6901 Simmons Loop
RIVERVIEW, FL 33578
Address
6901 Simmons Loop St Joseph's Hospital South
RIVERVIEW, FL 33578
Address
4211 VanDyke Road St Joseph's Hospital North
LUTZ, FL 33558
Address
3001 W DMLK Blvd St Joseph's Hospital
TAMPA, FL 33607
Address
300 Pinellas Street MS 36 Morton Plant Hospital
CLEARWATER, FL 33756
Address
3503 East Frontage Rd
TAMPA, FL 33607
Name Relationship Profession License Effective Date
WALDREP, NATHAN KEITH Supervising Prescribing Practitioner Medical Doctor 58834 04/29/2020

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Name Relationship Profession License Effective Date
GONNELLA, DAVID Prescribing Physician Assistant Physician Assistant 9114776 11/3/2021

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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.