License Verification

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TAED MACKLIN MOSES

License Number: PA9111050

Data As Of 12/2/2024

Profession
Physician Assistant
License
PA9111050
License Status
CLEAR/Active
Qualifications
Dispensing Practitioner
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
01/22/2018
Address of Record
1324 Lakeland Hills Blvd
LAKELAND, FL 33805
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
3030 Harden Blvd Lakeland Regional Health Medical Ctr
LAKELAND, FL 33803
Name Relationship Profession License Effective Date
DAVIS, KENDRA O Supervising Prescribing Practitioner Osteopathic Physician 16383 05/15/2020
FORESTIERE, MATTHEW Supervising Prescribing Practitioner Medical Doctor 138921 04/30/2020
GAUGLER, ANDREW CHRISTIAN FACS Supervising Prescribing Practitioner Osteopathic Physician 13562 05/01/2020
SEOANE, DEBRA L Supervising Prescribing Practitioner Medical Doctor 51161 04/27/2020
SOBOWALE, OLUMIDE OLUFUNMI Supervising Prescribing Practitioner Medical Doctor 63869 04/30/2020
SONTCHI, RICHARD DALE Supervising Prescribing Practitioner Medical Doctor 105155 04/30/2020
WALL, WARD B JR Supervising Prescribing Practitioner Medical Doctor 90509 04/30/2020

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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



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** 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.


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