License Verification

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TAYLOR MARIE WILLBUR

License Number: PA9114038

Data As Of 12/22/2024

Profession
Physician Assistant
License
PA9114038
License Status
CLEAR/Active
Qualifications
Prescribing
Dispensing Practitioner
License Expiration Date
1/31/2026
License Original Issue Date
02/04/2021
Address of Record
255 N Lakemont Ave
Rothman Orthopaedic
WINTER PARK, FL 32792
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
2501 North Orange Avenue Suite 235 AHMG Fracture Care at Orlando
ORLANDO, FL 32804
Address
255 N Lakemont Avenue Rothman Orthopaedic
WINTER PARK, FL 32792
Address
2325 W. Fairbanks Ave Suite2
WINTER PARK, FL 32789
Name Relationship Profession License Effective Date
AHMED, ATIF K Supervising Prescribing Practitioner Medical Doctor 149424 06/21/2021
DURFEE, RYAN ANTHONY M D Supervising Prescribing Practitioner Medical Doctor 129229 06/28/2021
HAWKS, MICHAEL ANTHONY Supervising Prescribing Practitioner Medical Doctor 104554 05/25/2021
HENDRIX, TIMOTHY WAYNE Supervising Dispensing Practitioner Medical Doctor 65142 07/18/2022

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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 12/22/2024



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** 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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