License Verification

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KATRINA DIONNE BLACK

License Number: PA9110311

Data As Of 12/22/2024

Profession
Physician Assistant
License
PA9110311
License Status
CLEAR/Active
Qualifications
Dispensing Practitioner
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
04/05/2017
Address of Record
5040 US HWY 98 N
Concentra Medical Center
LAKELAND, FL 33809
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
2600 Westhall Lane AdventHealth Centra Care
MAITLAND, FL 32751
Name Relationship Profession License Effective Date
BURKARD, WADE MICHAEL Supervising Dispensing Practitioner Medical Doctor 122097 11/07/2022
BURKARD, WADE MICHAEL Supervising Prescribing Practitioner Medical Doctor 122097 11/07/2022
GERBER, JOEL LAWRENCE Supervising Dispensing Practitioner Medical Doctor 84098 08/31/2020
GERBER, JOEL LAWRENCE Supervising Prescribing Practitioner Medical Doctor 84098 08/31/2020
HOLLAND, REUBEN WRIGHT III Supervising Dispensing Practitioner Medical Doctor 55507 08/31/2020
HOLLAND, REUBEN WRIGHT III Supervising Prescribing Practitioner Medical Doctor 55507 08/06/2020
TOOTLE, KAREN PATRICIA Supervising Dispensing Practitioner Medical Doctor 114067 05/07/2023
TOOTLE, KAREN PATRICIA Supervising Prescribing Practitioner Medical Doctor 114067 05/17/2023

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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 12/23/2024



* 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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