License Verification

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LAUREN ALYSSE SHAW

License Number: PA9110682

Data As Of 4/20/2026

Profession
Physician Assistant
License
PA9110682
License Status
Clear/Active
Qualifications
Prescribing
License Expiration Date
1/31/2028
License Original Issue Date
09/18/2017
Address of Record
6410 W Gulf to Lake Hwy
CRYSTAL RIVER, FL 34429
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
10740 Palm River Road Suite 200 TGH Brandon HelathPlex
TAMPA, FL 33619-4572
Address
502 W. HIGHLAND BLVD. CITRUS MEMORIAL HOSPITAL
INVERNESS, FL 34452
Address
3621 E. FOREST DR. GASTROENTEROLOGY ASSOICATES
INVERNESS, FL 34453
Name Relationship Profession License Effective Date
BEAU, JULLIAN STANLEY Supervising Prescribing Practitioner Medical Doctor 140858 04/15/2026
BRESLIN, ALEXANDER Supervising Prescribing Practitioner Medical Doctor 158385 04/17/2026
DEAN EVANS, DIANA JOSEPHINE Supervising Prescribing Practitioner Medical Doctor 144761 03/25/2026
DEPALMA, DARREN J Supervising Prescribing Practitioner Medical Doctor 101232 03/23/2026
DERR, CHARLOTTE Supervising Prescribing Practitioner Medical Doctor 85340 03/23/2026
GILLEN, JAMES P MD Supervising Prescribing Practitioner Medical Doctor 100819 03/23/2026
GOLDSTEIN, JESSICA ERIN Supervising Prescribing Practitioner Osteopathic Physician 11348 09/17/2025
HANSEN, ALLYSON PAIGE Supervising Prescribing Practitioner Osteopathic Physician 16824 03/26/2026
HAUGHEY, JOHN CHRISTOPHER Supervising Prescribing Practitioner Medical Doctor 126548 03/25/2026
HOWARD, CORY CHARTRANT Supervising Prescribing Practitioner Medical Doctor 155860 03/29/2026
HUNDLEY, KELSEY MARIE Supervising Prescribing Practitioner Medical Doctor 147047 01/09/2026
HUNT-HEINZEN, ELYSE MICHELE Supervising Prescribing Practitioner Medical Doctor 153554 03/28/2026
KIEL, JOHN MICHAEL Supervising Prescribing Practitioner Osteopathic Physician 15506 03/26/2026
MBOM, DANIEL Supervising Prescribing Practitioner Medical Doctor 167354 03/29/2026
MOEEN, RAKHSHINDA Supervising Prescribing Practitioner Osteopathic Physician 13965 03/26/2026
PRIDDY, AMANDA Supervising Prescribing Practitioner Medical Doctor 167415 03/29/2026
SANTIAGO RIVERA, VERONICA ALEXANDRA Supervising Prescribing Practitioner Medical Doctor 135678 04/01/2026
WEIN, DAVID ABRAHAM Supervising Prescribing Practitioner Medical Doctor 99292 04/11/2025
WEINSTEIN, ERIC STEVEN Supervising Prescribing Practitioner Medical Doctor 162727 03/27/2026
WILSON, JASON WAYNE Supervising Prescribing Practitioner Medical Doctor 105890 03/27/2026

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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 4/20/2026



* 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.