License Verification

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RAEANN COLE FULTZ

License Number: PA9118815

Data As Of 4/24/2026

Profession
Physician Assistant
License
PA9118815
License Status
Clear/Active
Qualifications
Prescribing
License Expiration Date
1/31/2028
License Original Issue Date
05/17/2024
Address of Record
19790 Wellen Park Blvd
suit 201A
VENICE, FL 34293
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
9114 Town Center Parkway Ste. 101
LAKEWOOD RANCH, FL 34202
Address
19790 Wellen Park Blvd SUIT 201b
VENICE, FL 34293
Address
1217 Jacaranda Blvd
VENICE, FL 34292
Name Relationship Profession License Effective Date
LACKEY, THOMAS C II Supervising Prescribing Practitioner Osteopathic Physician 10031 02/25/2026

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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 4/24/2026



* 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.