License Verification

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JACLYN SUZANNE RIEBEN

License Number: PA9114843

Data As Of 12/24/2024

Profession
Physician Assistant
License
PA9114843
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
08/23/2021
Address of Record
82 MACK BAYOU LOOP
Dermatology Specialists
SANTA ROSA BEACH, FL 32459
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
3 RACETRACK RD NE Dermatology Specialists
FORT WALTON BEACH, FL 32547
Address
12907 Panama City Beach Prkwy Dermatology Specialists
PANAMA CITY BEACH, FL 32407
Name Relationship Profession License Effective Date
GILMORE, MICHAEL DOW Supervising Prescribing Practitioner Medical Doctor 83504 11/21/2022
STICKLER, MICHAEL ALAN Supervising Prescribing Practitioner Medical Doctor 88808 01/08/2024

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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 12/24/2024



* 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.