License Verification

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KATELYN ELIZABETH OLDENBURG

License Number: PA9106063

Data As Of 12/23/2024

Profession
Physician Assistant
License
PA9106063
License Status
CLEAR/Active
Qualifications
Prescribing
Dispensing Practitioner
License Expiration Date
1/31/2026
License Original Issue Date
07/06/2011
Address of Record
209 Ponte Vedra Park Drive
PNTE VDRA BCH, FL 32082
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
480 Town Plaza Avenue Suite 150
PONTE VEDRA, FL 32081
Address
220 Ponte Vedra Park Drive Suite 140
PONTE VEDRA BEACH, FL 32082
Address
304 Ashourian Avenue Unit 107
SAINT AUGUSTINE, FL 32092
Address
11512 Lake Mead Avenue #513
JACKSONVILLE, FL 32256
Address
5472 1st Coast Highway Suite 3
FERNANDINA BEACH, FL 32034
Name Relationship Profession License Effective Date
BATES, CHRISTOPHER MICHAEL Supervising Prescribing Practitioner Medical Doctor 146236 02/07/2024
BURK, ROBERT WILLIAM III Supervising Dispensing Practitioner Medical Doctor 57422 05/07/2024
BURK, ROBERT WILLIAM III Supervising Prescribing Practitioner Medical Doctor 57422 01/19/2024
HANCOCK, ELLEN AMY Supervising Prescribing Practitioner Medical Doctor 154712 01/19/2024
HICKMAN, HOLLIE JO Supervising Prescribing Practitioner Osteopathic Physician 9337 01/19/2024
STERNBERG, EREZ GABRIEL Supervising Prescribing Practitioner Medical Doctor 88836 02/06/2024

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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.