License Verification

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JEFFREY WILLIAM KIENZLE

License Number: PA9101427

Data As Of 12/23/2024

Profession
Physician Assistant
License
PA9101427
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
09/11/2000
Address of Record
1921 WALDEMERE ST. SUITE 705
SARASOTA, FL 34239
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
1700 S. Tamiami Trail
SARASOTA, FL 34239
Name Relationship Profession License Effective Date
ASAAD, ADEL Supervising Prescribing Practitioner Medical Doctor 132915 09/23/2021
GHAMRA, ZIAD WALID Supervising Prescribing Practitioner Medical Doctor 105061 09/23/2021
GOEDICKE, HEIDI Supervising Prescribing Practitioner Medical Doctor 123843 09/23/2021
HARCUP, CRAIG HARVEY MD Supervising Prescribing Practitioner Medical Doctor 40338 09/23/2021
HURWITZ, KENNETH MICHAEL Supervising Prescribing Practitioner Medical Doctor 63644 09/23/2021
LOUTFI, RABIH HABIB Supervising Prescribing Practitioner Medical Doctor 101610 09/23/2021
MAZALEWSKI, WILLIAM DO Supervising Prescribing Practitioner Osteopathic Physician 15007 08/10/2022
MORGAN, KISHA JANEL Supervising Prescribing Practitioner Medical Doctor 84177 09/23/2021
PEREZ INGLES, DAVID Supervising Prescribing Practitioner Medical Doctor 160378 07/25/2023
PUE, CHARLES ALAN Supervising Prescribing Practitioner Medical Doctor 140087 09/23/2021
RAMIREZ, ANDREA VIVIANA Supervising Prescribing Practitioner Medical Doctor 145541 04/25/2024
REDDY, LAKSHMI GOWKANAPALLI Supervising Prescribing Practitioner Medical Doctor 123513 09/23/2021
SHAH, AMIT NAVIN Supervising Prescribing Practitioner Medical Doctor 120616 09/23/2021
SHERIFF, OMAR Supervising Prescribing Practitioner Medical Doctor 156983 08/10/2022
THIEL, DYLAN MATTHEW Supervising Prescribing Practitioner Osteopathic Physician 18516 04/25/2024

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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 12/23/2024



* 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.