License Verification

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JEREMY JASON CHURCH

License Number: PA9101355

Data As Of 12/22/2024

Profession
Physician Assistant
License
PA9101355
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
07/19/2000
Address of Record
123 Baptist Way
PENSACOLA, FL 32503
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
8888 Navarre Parkway
NAVARRE, FL 32566
Address
1110 Gulf Breeze Parkway
GULF BREEZE, FL 32561
Name Relationship Profession License Effective Date
ALLISS, SAMIR JOSE Supervising Prescribing Practitioner Osteopathic Physician 7247 06/30/2016
BERNARD, BRADLEY CHARLES MD Supervising Prescribing Practitioner Medical Doctor 103000 06/30/2016
BRANTLEY, MITCHELL DAVID Supervising Prescribing Practitioner Medical Doctor 87928 06/30/2016
DOLISTER, MICHAEL JAN Supervising Prescribing Practitioner Medical Doctor 66315 06/30/2016
EDLER, RAYME MICHELLE Supervising Prescribing Practitioner Medical Doctor 109913 06/30/2016
LUTHIN, WILLIAM NOLAN Supervising Prescribing Practitioner Medical Doctor 122535 12/18/2023
MCINTOSH, NATHAN PHILIP Supervising Prescribing Practitioner Medical Doctor 159274 12/18/2023
MUNCY, TYLAN ANDREW Supervising Prescribing Practitioner Medical Doctor 147733 12/18/2023
OWENBY, LAUREN Supervising Prescribing Practitioner Osteopathic Physician 12963 12/18/2023
PATRONI, CLYDE JOSEPH JR Supervising Prescribing Practitioner Medical Doctor 100780 07/12/2016
RILEY, SCOTT IVAN Supervising Prescribing Practitioner Medical Doctor 101153 06/30/2016
TRUJILLO, DEBORAH JOY Supervising Prescribing Practitioner Medical Doctor 146744 12/18/2023
WEHRY, LAURA MCCAULEY Supervising Prescribing Practitioner Medical Doctor 73145 06/30/2016
WELLS, BRANDEN LAMAUND Supervising Prescribing Practitioner Medical Doctor 82540 06/30/2016

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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



* 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.