License Verification

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JUDY JOMON JACOB

License Number: PA9121094

Data As Of 9/3/2026

Profession
Physician Assistant
License
PA9121094
License Status
Clear/Active
Qualifications
Dispensing Practitioner
Prescribing
License Expiration Date
1/31/2028
License Original Issue Date
11/18/2025
Address of Record
13670 Walsingham Rd
LARGO, FL 33774
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
Yes
Discipline on File
No
Public Complaint
No
Address
17512 Dona Michelle Dr Ste 5
TAMPA, FL 33647
Address
18610 Fernview St
LAND O LAKES, FL 33884
Address
1599 66th St N
SAINT PETERSBURG, FL 33710
Address
711 S Belcher Rd
CLEARWATER, FL 33764
Address
3351 N McMullen Booth Rd
CLEARWATER, FL 33761
Address
3440 W Dr Mlk Blvd Ste 100
TAMPA, FL 33607
Address
2331 4th St N
SAINT PETERSBURG, FL 33704
Address
11921 N Dale Mabry Hwy Ste 7
TAMPA, FL 33618
Address
1155 S Dale Mabry Hwy Ste 7
TAMPA, FL 33629
Address
4821 US Hwy 19 Ste 5
NEW PORT RICHEY, FL 34652
Address
11178 State Road 54 St B
NEW PORT RICHEY, FL 34655
Address
2645 S Florida Ave
LAKELAND, FL 33803
Address
2442 Bloomingdale Ave
VALRICO, FL 33586
Address
10125 Big Bend Rd
RIVERVIEW, FL 33578
Address
400 1st St N
WINTER HAVEN, FL 33881
Address
36245 US Hwy 27
HAINES CITY, FL 33844
Address
1601 W Timberlane Dr Ste 100
PLANT CITY, FL 33566
Name Relationship Profession License Effective Date
WALDREP, NATHAN KEITH Supervising Dispensing Practitioner Medical Doctor 58834 06/08/2026
WALDREP, NATHAN KEITH Supervising Prescribing Practitioner Medical Doctor 58834 06/08/2026

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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 9/3/2026



* 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.