License Verification

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JACK ANZILOTTI

License Number: PA9113011

Data As Of 12/23/2024

Profession
Physician Assistant
License
PA9113011
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
02/04/2020
Address of Record
52 W Underwood Street
ORLANDO, FL 32806
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
1335 Sligh Boulevard
ORLANDO, FL 32806
Address
77 W Underwood Street
ORLANDO, FL 32806
Name Relationship Profession License Effective Date
GIELOW, ANTHONY MICHAEL Supervising Prescribing Practitioner Osteopathic Physician 13926 06/02/2021
HERSPERGER, STEPHEN GREGORY Supervising Prescribing Practitioner Medical Doctor 128880 06/04/2021
IBRAHIM, JOSEPH ABDELLATIF Supervising Prescribing Practitioner Medical Doctor 111076 06/02/2021
MEINER, SEAN THOMAS Supervising Prescribing Practitioner Medical Doctor 139595 10/06/2020
SMITH, HOWARD GARY Supervising Prescribing Practitioner Medical Doctor 81905 06/02/2021

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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 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.


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