License Verification

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LISA M HABERSBRUNNER

License Number: PA9108678

Data As Of 12/2/2024

Profession
Physician Assistant
License
PA9108678
License Status
CLEAR/Active
Qualifications
Prescribing
Dispensing Practitioner
License Expiration Date
1/31/2026
License Original Issue Date
04/22/2015
Address of Record
EPCF
3090 Caruso Ct.
Unit 20
ORLANDO, FL 32806
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
16966 Cagan North Ridge Rd
CLERMONT, FL 34714
Address
52 West Underwood Street
ORLANDO, FL 32806
Address
555 W. SR 434
LONGWOOD, FL 32750
Address
10000 West Colonial Drive
OCOEE, FL 34761
Address
17000 Porter Road
WINTER GARDEN, FL 34787
Address
1001 E. Osceola Parkway
KISSIMMEE, FL 34744
Address
1900 Don Wickham
CLERMONT, FL 34711
Address
22316 US 27
LEESBURG, FL 34748
Name Relationship Profession License Effective Date
COSTANZO, KRISTA ALEXIS Supervising Prescribing Practitioner Medical Doctor 79409 03/21/2018
HENDRIX, TIMOTHY WAYNE Supervising Dispensing Practitioner Medical Doctor 65142 12/09/2020
KWATRA, SANJAY Supervising Prescribing Practitioner Medical Doctor 77907 03/07/2018
LYON, CAROLYN ROSE MD Supervising Prescribing Practitioner Medical Doctor 103952 03/21/2018
SKIPPER, MARTIN DAVID MD Supervising Prescribing Practitioner Medical Doctor 72577 03/07/2018

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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 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.


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