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KIM ANN FREDERICKSEN

License Number: ME126793

Data As Of 12/2/2024

Profession
Medical Doctor
License
ME126793
License Status
CLEAR/Active
License Expiration Date
1/31/2026
License Original Issue Date
01/27/2016
Address of Record
15255 MAX LEGGETT PKWY
JACKSONVILLE, FL 32218
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
COLE, JOHN STEPHEN Supervisor Medical Doctor 139230 08/20/2020
DURAN-GEHRING, PETRA E Supervising Prescribing Practitioner Medical Doctor 91161 08/15/2020
MYHRER, ERIK Supervising Prescribing Practitioner Medical Doctor 96634 08/14/2020
PARSONS-TUCKER, MELISSA ERIN Supervising Prescribing Practitioner Medical Doctor 122791 08/15/2020
SHANNON, ANDREW WHITE Supervisor Medical Doctor 125247 08/14/2020

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Name Relationship Profession License Effective Date
BIRMINGHAM, RICHARD ERVIN Prescribing Physician Assistant Physician Assistant 9113895 12/19/2022
EISMONT, TRACEY JEAN Prescribing Physician Assistant Physician Assistant 3182 6/26/2023
GABY, CHRISTINA Prescribing Physician Assistant Physician Assistant 9107129 5/14/2018
GAVLIK, MORGAN PAIGE Prescribing Physician Assistant Physician Assistant 9110306 8/15/2020
HINSON, JACOB CODY Prescribing Physician Assistant Physician Assistant 9108842 8/12/2024
JARAMILLO, DAVID HERNANDO Prescribing Physician Assistant Medical Doctor 96063 8/20/2020
JARAMILLO, DAVID HERNANDO Subordinate Medical Doctor 96063 8/17/2020
KERZHNER, EDUARD Prescribing Physician Assistant Physician Assistant 9111996 2/20/2020
LAMBERT, CAITLYN Prescribing Physician Assistant Physician Assistant 9109920 5/22/2017
MARTINEZ, TAMMY PRUITT Prescribing Physician Assistant Physician Assistant 9110936 3/12/2018
NGUYEN, MICHAEL TUAN Prescribing Physician Assistant Physician Assistant 9107834 5/4/2017
NICOLOSO, FRANCESCA MARINA Prescribing Physician Assistant Physician Assistant 9107277 3/15/2016
PEHLIVANOVIC, MIRNA Prescribing Physician Assistant Physician Assistant 9110562 8/31/2018
SHIRLEY, KALEENA LYNN Prescribing Physician Assistant Physician Assistant 9109143 3/15/2016

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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.