License Verification

Printer Friendly Version

TAYLOR TRACE

License Number: PA9112637

Data As Of 12/23/2024

Profession
Physician Assistant
License
PA9112637
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
09/30/2019
Address of Record
2237 Lithia Center Drive
VALRICO, FL 33596
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date
CAREY, JOHN EDMUND Supervising Prescribing Practitioner Medical Doctor 80791 03/16/2020
HANES, MICHAEL CHRISTOPHER Supervising Prescribing Practitioner Medical Doctor 121093 03/16/2020
MANN, JUSTIN DAVID MD Supervising Prescribing Practitioner Medical Doctor 128030 03/16/2020
REDDY, SATHAVARAM ARAVIND Supervising Prescribing Practitioner Medical Doctor 141290 03/16/2020
ROBERTS, CHRISTOPHER Supervising Prescribing Practitioner Medical Doctor 69788 03/16/2020
VINCENTY, CLAUDIO E Supervising Prescribing Practitioner Medical Doctor 44593 03/16/2020

Click on the License Number to view License Details for that Practitioner

Name Relationship Profession License Effective Date

Click on the License Number to view License Details for that Practitioner

Name Relationship Profession License Effective Date

Click on the License Number to view License Details for that Practitioner



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.