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MADELINE BACH

License Number: PA9109682

Data As Of 12/2/2024

Profession
Physician Assistant
License
PA9109682
License Status
CLEAR/Active
Qualifications
Dispensing Practitioner
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
07/27/2016
Address of Record
4040 49th St N
SAINT PETERSBURG, FL 33709
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
12190 Seminole Blvd Suite A
LARGO, FL 33778
Address
13531 State Rd. 54
ODESSA, FL 33556
Address
16521 US HWY 301 S Fast Track Urgent Care
SUN CITY CENTER, FL 33573
Address
799 W Lumsden Rd Fast Track Urgent Care
BRANDON, FL 33511
Address
564 Channelside Drive Fast Track Urgent Care
TAMPA, FL 33602
Address
5464 Lithia Pinecrest Drive Fast Track Urgent Care
LITHIA, FL 33547
Address
40545 US Hwy 19N Unit A Fast Track Urgent Care
TARPON SPRINGS, FL 34689
Address
6182 N US Highway 41 Fast Track Urgent Care
APOLLO BEACH, FL 33572
Address
11969 Sheldon Road Fast Track Urgent Care
WESTCHASE, FL 33626
Address
4505 Gunn Highway Fast Track Urgent Care
TAMPA, FL 33624
Address
5504 Gateway Blvd Fast Track Urgent Care
WESLEY CHAPEL, FL 33544
Address
303 W Palm Avenue Fast Track Urgent Care
TAMPA, FL 33602
Address
7601 Seminole Blvd Fast Track Urgent Care
SEMINOLE, FL 33772
Address
3251 66th St North Fast Track Urgent Care
SAINT PETERSBURG, FL 33710
Address
11406 US Highway 301 S Fast Track Urgent Care
RIVERVIEW, FL 33578
Address
3301 W Gandy Blvd Fast Track Urgent Care
TAMPA, FL 33611
Address
2401 4th St N
SAINT PETERSBURG, FL 33704
Name Relationship Profession License Effective Date
ABRAHAMS, MICHAEL Supervising Prescribing Practitioner Medical Doctor 137738 10/01/2023
AGDAMAG, PATRICK LEE Supervising Prescribing Practitioner Medical Doctor 104157 06/28/2017
AGUAYO, ELLIOTT JAMES Supervising Prescribing Practitioner Medical Doctor 118692 06/28/2017
BARNES, RICHARD R JR Supervising Prescribing Practitioner Medical Doctor 69285 11/01/2023
BARRON, SCOTT ALAN Supervising Prescribing Practitioner Medical Doctor 107217 06/28/2017
BERGMAN, JEFFERY JOSEPH Supervising Prescribing Practitioner Osteopathic Physician 11615 09/01/2023
BHATT, SUMEET RAJ MD Supervising Prescribing Practitioner Medical Doctor 107985 06/28/2017
BISHOP, TRACY MARIE Supervising Prescribing Practitioner Osteopathic Physician 16617 10/15/2023
BORUCKI, SIMON Supervising Prescribing Practitioner Medical Doctor 104560 06/28/2017
BROOKS, JOEL DEVOLENTINE Supervising Prescribing Practitioner Medical Doctor 34887 11/01/2023
BULLOCK, CORINNE MARY Supervising Prescribing Practitioner Medical Doctor 161025 11/01/2023
CANO, ROBERT ANTHONY DO Supervising Prescribing Practitioner Osteopathic Physician 7269 06/28/2017
CARABALLO, DAMIAN EDUARDO IV Supervising Prescribing Practitioner Medical Doctor 106340 06/28/2017
CASTANO, FRANCIS FAN M D Supervising Prescribing Practitioner Medical Doctor 64422 06/28/2017
CHEN, XANDUS Supervising Prescribing Practitioner Osteopathic Physician 13064 06/28/2017
CHRISTIANO, DANIELLE MARIE Supervising Prescribing Practitioner Medical Doctor 98327 06/28/2017
CISSE, NATA Supervising Prescribing Practitioner Medical Doctor 162132 11/15/2023
DE LUCA, LAURIE JEAN Supervising Prescribing Practitioner Medical Doctor 94019 06/28/2017
DESAI, AJAY Supervising Prescribing Practitioner Osteopathic Physician 12568 06/28/2017
DRAVIAM, SAMEER P Supervising Prescribing Practitioner Medical Doctor 116541 06/28/2017
DUBEY, JESSE VINCENT Supervising Prescribing Practitioner Osteopathic Physician 13099 06/28/2017
EVERS, NATALIE MARIE Supervising Prescribing Practitioner Medical Doctor 89128 06/28/2017
FROMMANN, NICOLE Supervising Dispensing Practitioner Medical Doctor 81429 03/04/2019
FROMMANN, NICOLE Supervising Prescribing Practitioner Medical Doctor 81429 03/04/2019
GASCA, ANDREW WILLIAM WINFIELD Supervising Prescribing Practitioner Osteopathic Physician 14573 06/28/2017
GELDART, DONALD BLAIR Supervising Prescribing Practitioner Medical Doctor 27412 06/28/2017
GOEHLERT, UWE GUSTAV Supervising Prescribing Practitioner Medical Doctor 86308 06/28/2017
GRAY, ADAM CLARKE Supervising Prescribing Practitioner Medical Doctor 140862 11/01/2023
KALDAS, MAGDY AYAD Supervising Prescribing Practitioner Medical Doctor 71928 06/28/2017
KEILMAN, CLINTON GABRIEL Supervising Prescribing Practitioner Medical Doctor 128366 06/28/2017
KELLOCK, HEIDI-MARIE ALEXANDRA M D Supervising Prescribing Practitioner Medical Doctor 114140 06/28/2017
KHAN, WAJAHAT ULLAH Supervising Prescribing Practitioner Medical Doctor 81138 06/28/2017
KINSEY, RICHARD RAYMOND JR Supervising Prescribing Practitioner Physician Assistant 9101145 11/01/2022
KLEINMAN, DANA Supervising Prescribing Practitioner Osteopathic Physician 11037 06/28/2017
KOONKITTI, PARICHART CANDY Supervising Prescribing Practitioner Medical Doctor 125284 06/28/2017
LAY, STEVEN F M D Supervising Prescribing Practitioner Medical Doctor 51047 06/28/2017
LIVOTI, REINALDO Supervising Prescribing Practitioner Physician Assistant 9118153 11/01/2023
LONGLEY, MICHAEL BRUCE Supervising Prescribing Practitioner Medical Doctor 94125 06/28/2017
LUCAS, JOANNE BRYAN Supervising Prescribing Practitioner Medical Doctor 97884 06/28/2017
LUDWIG, RICHARD EUGENE Supervising Prescribing Practitioner Physician Assistant 9102456 11/01/2023
MERRITT, RAYMOND LEE Supervising Prescribing Practitioner Osteopathic Physician 11538 06/28/2017
MILEY, KASIA Supervising Prescribing Practitioner Medical Doctor 152375 12/01/2023
NANDA, PAUL KALRA Supervising Dispensing Practitioner Medical Doctor 117861 03/04/2019
NANDA, PAUL KALRA Supervising Prescribing Practitioner Medical Doctor 117861 03/04/2019
NASR, RAMY MOHAMED ZAKI MD Supervising Prescribing Practitioner Medical Doctor 117829 06/28/2017
NAZARY, NEK NAZAR Supervising Prescribing Practitioner Medical Doctor 117096 06/28/2017
NESSELROADE, RYAN DAVID Supervising Prescribing Practitioner Medical Doctor 106189 06/28/2017
O'MALLEY, RACHEL ELIZABETH Supervising Prescribing Practitioner Medical Doctor 112862 06/28/2017
OSBORNE, AARON RYAN Supervising Prescribing Practitioner Medical Doctor 108215 06/28/2017
PATEL, TEJAS Supervising Prescribing Practitioner Osteopathic Physician 13790 06/28/2017
PAYOR, AUSTIN DANIEL Supervising Prescribing Practitioner Osteopathic Physician 10925 06/28/2017
PIERRO, ANTHONY PETER Supervising Prescribing Practitioner Osteopathic Physician 12031 06/28/2017
PIGMAN, EDWIN CARY MD Supervising Prescribing Practitioner Medical Doctor 66985 06/28/2017
ROCKLER, KENDALL MICHELLE Supervising Prescribing Practitioner Medical Doctor 114880 12/01/2023
SAMUEL, PETER AIAD Supervising Prescribing Practitioner Medical Doctor 132116 06/28/2017
SANTAYANA, RICARDO JR Supervising Prescribing Practitioner Medical Doctor 119115 06/28/2017
SCHWARTZ, MATTHEW ABRAM Supervising Prescribing Practitioner Medical Doctor 135491 01/05/2023
SCOTT, DAVID Supervising Prescribing Practitioner Medical Doctor 143679 01/10/2023
SECREST, JULIE K Supervising Prescribing Practitioner Medical Doctor 110718 06/28/2017
SELLEY, JEREMY KENT Supervising Prescribing Practitioner Osteopathic Physician 13512 01/10/2023
SHAH, MANASI SAMIR Supervising Prescribing Practitioner Medical Doctor 127451 06/28/2017
SIMPKINS, JANELL LYNN Supervising Prescribing Practitioner Medical Doctor 120613 06/28/2017
SIMPSON, ALISON L Supervising Prescribing Practitioner Medical Doctor 74810 06/28/2017
SMITH, MATTHEW WAYNE Supervising Prescribing Practitioner Osteopathic Physician 16446 01/19/2023
SOBKY, CHRISTIAN NADER Supervising Prescribing Practitioner Medical Doctor 132030 06/28/2017
SPENCER, ANDREW JOSEPH Supervising Prescribing Practitioner Medical Doctor 122767 06/28/2017
STAFF, KRISTINE E Supervising Prescribing Practitioner Medical Doctor 117924 06/28/2017
STULTZ, MEGAN Supervising Prescribing Practitioner Medical Doctor 130382 06/28/2017
TAHER, RAMEZ Supervising Prescribing Practitioner Medical Doctor 101043 06/28/2017
TAVERAS, ANABELLE NATALIA Supervising Prescribing Practitioner Medical Doctor 148550 11/01/2022
TEPPER, EVAN BRETT MD Supervising Prescribing Practitioner Medical Doctor 60190 06/28/2017
THOMAS, SHERWIN ZACHARIAH Supervising Prescribing Practitioner Medical Doctor 149747 01/20/2022
THUROW, CHANTELLE LANEE Supervising Prescribing Practitioner Osteopathic Physician 11505 06/28/2017
TICKETT, SHELLEY SMITH Supervising Prescribing Practitioner Medical Doctor 90313 06/28/2017
TIMMEL, MARK Supervising Prescribing Practitioner Medical Doctor 151869 01/01/2023
TIRHEIMER, WENZEL III Supervising Prescribing Practitioner Medical Doctor 83294 06/28/2017
UMANSKY, AARON JOSEPH Supervising Prescribing Practitioner Medical Doctor 151420 01/10/2023
VELASCO, WILLIAM J Supervising Prescribing Practitioner Medical Doctor 121914 06/28/2017
VIBHAKAR, ARJUN Supervising Prescribing Practitioner Medical Doctor 128122 06/28/2017
VOEGTLI, KRYSTYNA RENEE Supervising Prescribing Practitioner Medical Doctor 114913 06/28/2017
WHITE, GREGORY RICHARD MR Supervising Prescribing Practitioner Medical Doctor 39946 06/28/2017
WHITE, JEREMY V Supervising Prescribing Practitioner Osteopathic Physician 11399 06/28/2017
YOHANNES-PETERS, FITSUM Supervising Prescribing Practitioner Medical Doctor 92187 06/28/2017
YONTECK, FREDERICK TODD Supervising Prescribing Practitioner Medical Doctor 87287 06/28/2017
ZAHARIS, CONSTANTINE ZACHARY MD Supervising Prescribing Practitioner Medical Doctor 112437 06/28/2017
ZAHN, ELISE JOY Supervising Prescribing Practitioner Osteopathic Physician 7897 06/28/2017

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Name Relationship Profession License Effective Date
SORDAN, MICHAEL ROLF Prescribing Physician Assistant Physician Assistant 9115648 2/1/2022

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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.