License Verification

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ALAN STANLEY DOMACK

License Number: PA9110804

Data As Of 12/4/2024

Profession
Physician Assistant
License
PA9110804
License Status
DELINQUENT/
Qualifications
Prescribing
License Expiration Date
1/31/2024
License Original Issue Date
10/03/2017
Address of Record
3334 Capital Medical Blvd
Ste 400
TALLAHASSEE, FL 32308
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
803 W Main Street
PERRY, FL 32347
Name Relationship Profession License Effective Date
OBERSTE, DAVID JASON Supervising Prescribing Practitioner Medical Doctor 102057 11/26/2019

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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 12/4/2024



* 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.