License Number: MA79473Data As Of 3/1/2024
|License Expiration Date
|License Original Issue Date
|Address of Record
|If further information is needed, please contact the Department of Health at (850) 488-0595.
|Discipline on File
The information on this page is a secure, primary source for license verification provided by the Florida Department of Health, Division of Medical Quality Assurance. This website is maintained by Division staff and is updated immediately upon a change to our licensing and enforcement database.