License Verification

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BAO-KHUYEN NGUYEN LY

License Number: PA9112468

Data As Of 4/3/2025

Profession
Physician Assistant
License
PA9112468
License Status
CLEAR/Active
Qualifications
Prescribing
Dispensing Practitioner
License Expiration Date
1/31/2026
License Original Issue Date
09/05/2019
Address of Record
13670 Walsingham Rd
LARGO, FL 33774
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
11178 State Road 54, Suite B
NEW PORT RICHEY, FL 34655
Address
11921 N. Dale Mabry Hwy, Ste 7
TAMPA, FL 33618
Address
1599 66th Street N
SAINT PETERSBURG, FL 33710
Address
6455 Gulf Blvd
ST PETE BEACH, FL 33706
Address
2331 4th Street North
SAINT PETERSBURG, FL 33704
Address
3351 N McMullen Booth Rd
CLEARWATER, FL 33761
Address
17152 Donna Michelle Drive
TAMPA, FL 33647
Address
244 bloomingdale ave
VALRICO, FL 33596
Address
18610 Fern View st
LAND O LAKES, FL 34638
Address
10125 Big Bend Rd
, 33578
Address
3440 W. Dr MLK Blvd #100
TAMPA, FL 33607
Address
711 S Belcher Road
CLEARWATER, FL 33764
Address
4821 US Hwy ,Suite 5
NEW PORT RICHEY, FL 34652
Address
1155 S. Dale Mabry Hwy, Ste 7
TAMPA, FL 33629
Address
400 1st St . N
WINTER HAVEN, FL 33881
Name Relationship Profession License Effective Date
WALDREP, NATHAN KEITH Supervising Dispensing Practitioner Medical Doctor 58834 11/18/2020

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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 4/3/2025



* 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.


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.