License Verification

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BRIAN KEITH BONOMO

License Number: PA9101264

Data As Of 12/22/2024

Profession
Physician Assistant
License
PA9101264
License Status
CLEAR/Active
Qualifications
Prescribing
Dispensing Practitioner
License Expiration Date
1/31/2026
License Original Issue Date
07/17/2000
Address of Record
525 NO. DACIE POINT
LECANTO, FL 34461-8547
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
9401 SW HWY 200 SUNCOAST DERMATOLOGY SKIN SURGERY
OCALA, FL 34481
Name Relationship Profession License Effective Date
HOLCOMBE, KEVIN WESTRAY Supervising Prescribing Practitioner Medical Doctor 112246 08/15/2023
MASSULLO, RALPH EUGENE JR Supervising Dispensing Practitioner Medical Doctor 54469 01/01/2021
MASSULLO, RALPH EUGENE JR Supervising Prescribing Practitioner Medical Doctor 54469 01/01/2021

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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.