License Verification

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TARA WYCKOFF

License Number: PA9111026

Data As Of 6/6/2025

Profession
Physician Assistant
License
PA9111026
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
01/11/2018
Address of Record
Mayo Clinic
4500 San Pablo Road S
JACKSONVILLE, FL 32224
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
7826 Ozark Drive Mayo Clinic
JACKSONVILLE, FL 32256
Name Relationship Profession License Effective Date
BODIFORD, KATHERINE JANE Supervising Prescribing Practitioner Medical Doctor 110933 06/29/2021
DEGESYS, CATHERINE ABBIE Supervising Prescribing Practitioner Medical Doctor 147887 06/28/2021
SOKUMBI, OLAYEMI Supervising Prescribing Practitioner Medical Doctor 138881 06/29/2021
WENTWORTH, ASHLEY Supervising Prescribing Practitioner Medical Doctor 145103 05/27/2021

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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 6/6/2025



* 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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