License Verification

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DENNIS LEROY FORTNER III

License Number: PA9105894

Data As Of 5/20/2024

Profession
Physician Assistant
License
PA9105894
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
01/24/2011
Address of Record
60 MEMORIAL MEDICAL PARKWAY
ADVENT HEALTH PALM COAST
PALM COAST, FL 32164
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date
ALEMAN-BERMUDEZ, JAIME J Supervising Prescribing Practitioner Medical Doctor 49940 03/29/2018
ALONSO, LEONARDO LAZARO Supervising Prescribing Practitioner Osteopathic Physician 6584 03/29/2018
AMIN, SHILPA KIRIT Supervising Prescribing Practitioner Medical Doctor 118558 03/29/2018
ATTLESEY, MARK GRAHAM Supervising Prescribing Practitioner Medical Doctor 71653 03/29/2018
BAKOR, NADIA Supervising Prescribing Practitioner Medical Doctor 131303 03/29/2018
BLAKE, STEVEN MITCHELL M D Supervising Prescribing Practitioner Medical Doctor 58519 03/29/2018
BRACE, RONALD JOHN Supervising Prescribing Practitioner Medical Doctor 120282 03/29/2018
CHAPMAN, JENNIFER COLES Supervising Prescribing Practitioner Medical Doctor 125751 03/29/2018
CHEANVECHAI, DAYCHA Supervising Prescribing Practitioner Medical Doctor 76415 03/29/2018
CHRISTEN, NEIL LEONARD Supervising Prescribing Practitioner Medical Doctor 129370 03/29/2018
CURRIE, MICHAEL JOHN Supervising Prescribing Practitioner Osteopathic Physician 14738 03/29/2018
DAVIS, DAVID RICHARD Supervising Prescribing Practitioner Medical Doctor 96442 03/29/2018
DEJESUS JARQUIN, OTILIA Supervising Prescribing Practitioner Medical Doctor 105497 04/25/2019
EUWEMA, MICHAEL SCOTT Supervising Prescribing Practitioner Medical Doctor 91648 03/29/2018
FORSTER, JOHN GEORGE III Supervising Prescribing Practitioner Medical Doctor 69993 03/29/2018
GOODFRIEND, STEVEN DAVID Supervising Prescribing Practitioner Medical Doctor 84608 03/29/2018
GYARMATHY, RAYMOND HOWARD Supervising Prescribing Practitioner Medical Doctor 53513 03/29/2018
HOIDA, JEFFREY SCOTT MD Supervising Prescribing Practitioner Medical Doctor 136257 04/25/2019
HOIDA, SHIELDS DUSS Supervising Prescribing Practitioner Medical Doctor 125526 04/25/2019
HUMPHRIES, JERRY FRANKLIN JR Supervising Prescribing Practitioner Medical Doctor 112733 03/29/2018
JENKINS, FREDERICK LUCAS Supervising Prescribing Practitioner Medical Doctor 83245 03/29/2018
JOHNSON, JENNIFER BURKE Supervising Prescribing Practitioner Medical Doctor 115159 03/29/2018
KEENER, JANEL LAURA Supervising Prescribing Practitioner Medical Doctor 115434 03/29/2018
KING, FORREST JOSEPH Supervising Prescribing Practitioner Medical Doctor 124146 03/29/2018
KING, KENNETH Supervising Prescribing Practitioner Osteopathic Physician 8648 03/29/2018
KOURY, RONALD FORREST D O Supervising Prescribing Practitioner Osteopathic Physician 8090 03/29/2018
MANTHA, KALYAN C Supervising Prescribing Practitioner Medical Doctor 122523 09/20/2018
MCCABE KLINE, KRISTIN BOND Supervising Prescribing Practitioner Medical Doctor 98422 12/01/2015
MENZE, ROGER MICHEEL Supervising Prescribing Practitioner Medical Doctor 68199 03/29/2018
MUCCIOLO, PAUL MD Supervising Prescribing Practitioner Medical Doctor 69281 12/01/2015
OLIVER, RADAMES ALBERTO Supervising Prescribing Practitioner Medical Doctor 67906 03/29/2018
PAPAVASILIOU, JOHN JOSEPH Supervising Prescribing Practitioner Medical Doctor 66371 03/29/2018
ROSADO, MELISSA Supervising Prescribing Practitioner Medical Doctor 125407 03/29/2018
STERN, NEIL DAVID Supervising Prescribing Practitioner Osteopathic Physician 8723 03/29/2018
SWANSON, TERRELL E JOHN Supervising Prescribing Practitioner Medical Doctor 111251 03/29/2018
THOMAS, ROBERT LOUIS Supervising Prescribing Practitioner Osteopathic Physician 8592 03/29/2018
WARRINGTON, STEVEN Supervising Prescribing Practitioner Medical Doctor 131907 03/29/2018
WINNINGHAM, DAVID JASON Supervising Prescribing Practitioner Osteopathic Physician 12586 03/29/2018
WOOD, STEPHANIE KAREN Supervising Prescribing Practitioner Medical Doctor 35012 03/29/2018
ZAGER, SCOTT LAWRENCE Supervising Prescribing Practitioner Medical Doctor 91062 03/29/2018
ZERNIAL, CHRISTOPHER B Supervising Prescribing Practitioner Medical Doctor 131593 03/29/2018

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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 5/20/2024



* 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.