License Verification

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OTILIA DEJESUS

License Number: ME105497

Data As Of 12/2/2024

Profession
Medical Doctor
License
ME105497
License Status
CLEAR/Active
License Expiration Date
1/31/2026
License Original Issue Date
09/10/2009
Address of Record
14526 PLUMOSA DRIVE
JACKSONVILLE BEACH, FL 32250
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
FORSTER, JOHN GEORGE III Supervising Prescribing Practitioner Medical Doctor 69993 03/08/2021
TYMKOWICZ, ALEXANDRIA Supervising Prescribing Practitioner Medical Doctor 156308 03/14/2023
WALKER, GEORGE HAROLD MD Supervising Prescribing Practitioner Medical Doctor 70189 10/25/2022

Click on the License Number to view License Details for that Practitioner

Name Relationship Profession License Effective Date
BAKOR, NADIA Prescribing Physician Assistant Medical Doctor 131303 4/25/2019
BAKOR, NADIA Subordinate Medical Doctor 131303 4/1/2019
BENDA, MEGAN NICOLE Prescribing Physician Assistant Physician Assistant 9109829 7/11/2018
BRUCE, MICHAEL THOMAS Prescribing Physician Assistant Physician Assistant 9109680 4/24/2019
CHAPMAN, JENNIFER COLES Subordinate Medical Doctor 125751 1/6/2021
CRISSMAN, WILLIAM WARD Prescribing Physician Assistant Physician Assistant 9105322 4/25/2019
FEHR, LORI L Prescribing Physician Assistant Physician Assistant 9107477 4/23/2019
FORTNER, DENNIS LEROY III Prescribing Physician Assistant Physician Assistant 9105894 4/25/2019
GOINS, DAVID SCOTT Prescribing Physician Assistant Physician Assistant 9102736 4/1/2019
HINTON, JENNIFER MARIE Prescribing Physician Assistant Physician Assistant 9103166 4/23/2019
HOFFMAN, SUSAN Prescribing Physician Assistant Physician Assistant 9106725 4/1/2019
JURICH, ANGEL CHRISTINE Prescribing Physician Assistant Physician Assistant 9108136 4/24/2019
MANTHA, KALYAN C Subordinate Medical Doctor 122523 4/1/2019
MARTIN, AMBER REBEKAH Prescribing Physician Assistant Physician Assistant 9103989 4/24/2019
MOFFATT, MEGAN H Prescribing Physician Assistant Physician Assistant 9106786 4/25/2019
NAGEL, JASON ASHER Prescribing Physician Assistant Physician Assistant 9103432 11/2/2018
NEW, ANNA RUTH-MILDRED Prescribing Physician Assistant Physician Assistant 9110750 4/25/2019
QUADER, MOHAMMED AZIZUL Prescribing Physician Assistant Medical Doctor 91402 4/1/2019
QUADER, MOHAMMED AZIZUL Subordinate Medical Doctor 91402 4/1/2019
RITCHIE, MARK SALVATORE Prescribing Physician Assistant Physician Assistant 9107818 4/24/2019
ROBINSON, CINDY LIZ Prescribing Physician Assistant Physician Assistant 9104267 7/11/2018
SASSO, LEONARD GERARD Prescribing Physician Assistant Physician Assistant 9105451 4/25/2019
SILVA, MICHELLE M Prescribing Physician Assistant Medical Doctor 129273 4/25/2019
SILVA, MICHELLE M Subordinate Medical Doctor 129273 4/1/2019
SMITH, CAROLINE OLGA Prescribing Physician Assistant Physician Assistant 9106283 4/24/2019
WARD, MATTHEW MORGAN Prescribing Physician Assistant Physician Assistant 9108249 4/1/2019
WARD, WILLIAM ALBERT Prescribing Physician Assistant Physician Assistant 9108936 4/23/2019
WATERS, DOUGLAS LEE Prescribing Physician Assistant Physician Assistant 9106355 4/1/2019

Click on the License Number to view License Details for that Practitioner

Name Relationship Profession License Effective Date

Click on the License Number to view License Details for that Practitioner



No Continuing Education Hours Received from Approved Providers As Of 12/2/2024



* 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.