License Verification

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COURTNEY BALCOME JOHNSON

License Number: PA9110696

Data As Of 12/23/2024

Profession
Physician Assistant
License
PA9110696
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
09/19/2017
Address of Record
8340 Lakewood Ranch Blvd
STE 300
LAKEWOOD RANCH, FL 34202
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
6202 17th Ave West
BRADENTON, FL 34209
Name Relationship Profession License Effective Date
BOYETTE, MELISSA MAHIQUEZ Supervising Prescribing Practitioner Medical Doctor 103549 05/16/2019
CASHEN, DAVID VINCENT Supervising Prescribing Practitioner Medical Doctor 99185 05/16/2019
DATTILO, JONATHAN ROSS Supervising Prescribing Practitioner Medical Doctor 144420 10/14/2020
DERMARKARIAN, PATRICK GEORGE Supervising Prescribing Practitioner Medical Doctor 140651 01/03/2020
HARKESS, JOHN WILSON Supervising Prescribing Practitioner Medical Doctor 132666 05/16/2019
KOTHARI, PARTH Supervising Prescribing Practitioner Medical Doctor 167737 09/16/2024
KUMAR, AVINASH GUPTA Supervising Prescribing Practitioner Medical Doctor 82887 05/16/2019
LAMAR, DANIEL SCOTT JR Supervising Prescribing Practitioner Medical Doctor 88228 05/16/2019
O'DALY BAQUERO, ANDRES EDUARDO Supervising Prescribing Practitioner Medical Doctor 126890 05/16/2019
OTTE, ROBERT STEPHEN Supervising Prescribing Practitioner Medical Doctor 141436 01/23/2020
PACANA, MATTHEW JOHN Supervising Prescribing Practitioner Medical Doctor 157260 11/01/2024
SCHAFER, STEVEN JAY Supervising Prescribing Practitioner Medical Doctor 77986 05/16/2019
SHEREFF, MICHAEL JOSEPH Supervising Prescribing Practitioner Medical Doctor 101274 05/16/2019
SIMMONS, SARA PUTNAM Supervising Prescribing Practitioner Medical Doctor 113187 05/16/2019
SUNDBERG, ERIC BORDEN Supervising Prescribing Practitioner Medical Doctor 120448 05/16/2019
VALADIE, ALAN LEE Supervising Prescribing Practitioner Medical Doctor 70378 05/16/2019
VALADIE, ARTHUR LEON Supervising Prescribing Practitioner Medical Doctor 71811 05/16/2019

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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.


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.