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BARON THAXTON MULLIS

License Number: ME113789

Data As Of 12/2/2024

Profession
Medical Doctor
License
ME113789
License Status
CLEAR/Active
License Expiration Date
1/31/2026
License Original Issue Date
07/25/2012
Address of Record
151 E Redstone Ave
CRESTVIEW, FL 32539
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
MATTEUZZI, KATIE LOU Supervising Prescribing Practitioner Osteopathic Physician 19359 02/13/2024

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Name Relationship Profession License Effective Date
AMBROSE, JESSICA Prescribing Physician Assistant Physician Assistant 9110160 7/2/2021
BERRY, RANAE SHANNON Prescribing Physician Assistant Physician Assistant 9103545 7/2/2021
BULLMAN, JONATHAN FAIN Prescribing Physician Assistant Physician Assistant 9107709 2/2/2021
CARLSON, WILLIAM SHAW Prescribing Physician Assistant Medical Doctor 121446 2/2/2021
EVERETT, WARREN UMANDAP Prescribing Physician Assistant Physician Assistant 9105831 9/17/2021
PATRONIS ADAMS, MARIA Prescribing Physician Assistant Physician Assistant 9111206 7/2/2021
ROMAN, JULIE Prescribing Physician Assistant Physician Assistant 9111426 8/18/2023
SAMSON, JESSICA AURELIO Prescribing Physician Assistant Physician Assistant 9103076 7/2/2021
SIMMONS, LEONARD WILLIAM Prescribing Physician Assistant Physician Assistant 9103209 6/9/2021
WILEY, AMY HELEN Prescribing Physician Assistant Physician Assistant 9111747 7/2/2021
WINDFELDER, CHARLES BERNARD Prescribing Physician Assistant Physician Assistant 9103273 7/2/2021

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Name Relationship Profession License Effective Date

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



* 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.