License Verification

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CHARDE BREANN HOLT

License Number: PA9112643

Data As Of 12/2/2024

Profession
Physician Assistant
License
PA9112643
License Status
CLEAR/Active
Qualifications
Prescribing
Dispensing Practitioner
License Expiration Date
1/31/2026
License Original Issue Date
10/01/2019
Address of Record
40100 US HWY 27
DAVENPORT, FL 33837
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
AGBI, ANDREW OMOH Supervising Prescribing Practitioner Osteopathic Physician 10970 02/24/2022
ALDAPE, ADOLFO ALEJANDRO Supervising Prescribing Practitioner Medical Doctor 126571 08/25/2021
ALEXANDER, LARRY LEON Supervising Prescribing Practitioner Medical Doctor 80072 09/16/2021
ALEXIS, JANEAH Supervising Prescribing Practitioner Osteopathic Physician 20003 06/28/2023
ALZATE, ALBERTO ISAAC Supervising Prescribing Practitioner Medical Doctor 81335 08/25/2021
ARRIAGA-ONEILL, YARITZA MD Supervising Prescribing Practitioner Medical Doctor 111529 08/25/2021
BARLOW, RYAN THOMAS Supervising Prescribing Practitioner Medical Doctor 149752 09/16/2021
BEATTY, ROBERT PATRICK Supervising Prescribing Practitioner Medical Doctor 97579 06/03/2022
BERMAN, RONALD Supervising Prescribing Practitioner Medical Doctor 79188 09/16/2021
BERRY, RANAE SHANNON Supervising Prescribing Practitioner Physician Assistant 9103545 08/25/2022
BOYER, MICHAEL ANTHONY Supervising Prescribing Practitioner Osteopathic Physician 7483 09/16/2021
BRATCHER, MONTEL FRABRECIO Supervising Prescribing Practitioner Medical Doctor 136544 09/16/2021
CUNNINGHAM, MICHAEL F Supervising Prescribing Practitioner Osteopathic Physician 14869 08/25/2021
DAWKINS, DONALD Supervising Prescribing Practitioner Osteopathic Physician 10160 08/25/2021
ECHAGUE COLMAN, RAMON ANTONIO Supervising Prescribing Practitioner Medical Doctor 111476 08/25/2021
EVERS, NATALIE MARIE Supervising Prescribing Practitioner Medical Doctor 89128 09/16/2021
FALKOWSKI, ROBERT PAUL SR Supervising Prescribing Practitioner Medical Doctor 60514 09/16/2021
FARHAT, HASSAN YAHYA Supervising Prescribing Practitioner Medical Doctor 82249 09/16/2021
FARRELL, DANIEL RAYMOND MD Supervising Prescribing Practitioner Medical Doctor 99257 06/19/2023
FERNANDEZ OLIVERO, GERARDO ANDRES Supervising Prescribing Practitioner Medical Doctor 139063 11/07/2023
FOPPE, MARK ANDREW DO Supervising Prescribing Practitioner Osteopathic Physician 8701 08/25/2021
FREELS, KEVIN Supervising Prescribing Practitioner Medical Doctor 131199 09/16/2021
GOORLAND, JEFFREY Supervising Prescribing Practitioner Medical Doctor 136109 08/25/2021
GOYAL, KAMAL KUMAR MD Supervising Prescribing Practitioner Medical Doctor 132449 01/18/2022
HADDAD, JOE D O Supervising Prescribing Practitioner Osteopathic Physician 15867 11/08/2023
HENDRIX, TIMOTHY WAYNE Supervising Dispensing Practitioner Medical Doctor 65142 09/22/2022
ISAKHAROV, MARGARITA Supervising Prescribing Practitioner Medical Doctor 117365 08/17/2023
JASIMUDDIN, SHEIKH KHWAJA Supervising Prescribing Practitioner Medical Doctor 100463 08/25/2021
LALANI, FARAH NAUSHIR Supervising Prescribing Practitioner Osteopathic Physician 10814 09/16/2021
LIN, EDWARD C Supervising Prescribing Practitioner Osteopathic Physician 11547 09/16/2021
LIPSMEYER, CHRISTOPHER PAUL Supervising Prescribing Practitioner Medical Doctor 102475 09/16/2021
MARAVEGIAS, ISMENE NINA Supervising Prescribing Practitioner Medical Doctor 85168 09/16/2021
MASIH, RAVI BAKHSHISH Supervising Prescribing Practitioner Medical Doctor 75539 08/25/2021
MCHALE, MICHAEL SHAMUS Supervising Prescribing Practitioner Osteopathic Physician 6360 09/16/2021
MIAH, BAHAR Supervising Prescribing Practitioner Medical Doctor 108183 08/25/2021
PAGAN-RIVERA, REY YAMIL Supervising Prescribing Practitioner Medical Doctor 134981 09/16/2021
PALMA, ALEXANDER Supervising Prescribing Practitioner Medical Doctor 116475 02/04/2024
PATEL, ANKIT B Supervising Prescribing Practitioner Medical Doctor 142112 08/25/2021
PIRVAN, DANIEL FLAVIUS Supervising Prescribing Practitioner Medical Doctor 137055 08/25/2021
PRUITT, JAMES ALLEN Supervising Prescribing Practitioner Medical Doctor 142076 08/25/2021
PRYTKOV, ALEXEI MIKHAILOVICH Supervising Prescribing Practitioner Medical Doctor 123293 08/25/2021
PUREWAL, AMARPAL K Supervising Prescribing Practitioner Medical Doctor 121581 01/18/2024
REDDY, MOVVA NAVIN Supervising Prescribing Practitioner Medical Doctor 93812 08/15/2023
SANTIAGO-APONTE, RAFAEL A Supervising Prescribing Practitioner Medical Doctor 114771 08/25/2021
SHAPIRO, LAUREN Supervising Prescribing Practitioner Medical Doctor 149050 08/25/2021
SHARMA, MIRAND REEB Supervising Prescribing Practitioner Medical Doctor 82852 09/16/2021
SIGNORE, STEPHEN JOSEPH MR Supervising Prescribing Practitioner Physician Assistant 2754 08/25/2021
SNEAD, THOMAS LEE II Supervising Prescribing Practitioner Medical Doctor 116520 08/25/2021
SPRY, DONAL JEREMY Supervising Prescribing Practitioner Osteopathic Physician 11298 08/10/2023
STRICKLEN, HILLARY E Supervising Prescribing Practitioner Osteopathic Physician 13908 05/01/2023
VELASCO, ANDRES FELIPE Supervising Prescribing Practitioner Medical Doctor 96936 09/16/2021
VERGARA, ROBERT JOHN CRUZ Supervising Prescribing Practitioner Medical Doctor 95775 11/17/2022
WHITNEY, KEYNA JURI Supervising Prescribing Practitioner Medical Doctor 133690 08/25/2022
ZIMMER, BRIAN Supervising Prescribing Practitioner Osteopathic Physician 18890 07/25/2022

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Name Relationship Profession License Effective Date
HANCOCK, MAE ROSANNE VILLEGAS Prescribing Physician Assistant Physician Assistant 9105391 1/16/2021

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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.