License Verification

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EBONIQUE S MAEWEATHERS

License Number: PA9100975

Data As Of 12/23/2024

Profession
Physician Assistant
License
PA9100975
License Status
CLEAR/Active
Qualifications
Prescribing
Dispensing Practitioner
License Expiration Date
1/31/2026
License Original Issue Date
06/28/1999
Address of Record
12421 S. Orange Blossom Trail
Concentra
ORLANDO, FL 32837
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
2221 S.W. 19th ave rd Concentra
OCALA, FL 34471
Address
210 S. LAKE ST., SUITE 4 Concentra
LEESBURG, FL 34748
Address
8119 South Orange Ave Concentra
ORLANDO, FL 32809
Address
4780 N. ORANGE BLOSSOM TRAIL Concentra
ORLANDO, FL 32810
Name Relationship Profession License Effective Date
AGATEP, DENISE ELIZABETH Supervising Dispensing Practitioner Medical Doctor 90631 06/01/2022

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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 12/23/2024



* 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.


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.