License Verification

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NATA CISSE

License Number: ME162132

Data As Of 12/2/2024

Profession
Medical Doctor
License
ME162132
License Status
CLEAR/Active
Qualifications
Dispensing Practitioner
License Expiration Date
1/31/2025
License Original Issue Date
04/24/2023
Address of Record
3015 3015 N Rocky Point Dr E
408
Tampa
TAMPA, FL 33607
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

Click on the License Number to view License Details for that Practitioner

Name Relationship Profession License Effective Date
BACH, MADELINE Prescribing Physician Assistant Physician Assistant 9109682 11/15/2023
BARQUIN, JOSE MIGUEL JR Prescribing Physician Assistant Medical Doctor 131689 9/1/2024
BEAUCHAMP, STEFANIE Prescribing Physician Assistant Physician Assistant 9115527 11/15/2023
BOLTON, ASHLEY MARIE Prescribing Physician Assistant Physician Assistant 9108069 11/15/2023
BOWMAN, RYAN SCOTT Prescribing Physician Assistant Physician Assistant 9117823 11/15/2023
BREEN, JENA LYNN Prescribing Physician Assistant Physician Assistant 9108857 11/15/2023
CASELLAS, AMBER CHEYENNE Prescribing Physician Assistant Physician Assistant 9109320 11/15/2023
CLINE, JESSICA MARIE LYNN Prescribing Physician Assistant Physician Assistant 9116036 11/15/2023
CRAMER, GREGORY ROBERT Prescribing Physician Assistant Physician Assistant 9116628 11/15/2023
CUNNINGHAM, ANDREW Prescribing Physician Assistant Physician Assistant 9112114 11/15/2023
DAVIES, MELANIE JAYNE Prescribing Physician Assistant Physician Assistant 9109114 11/15/2023
DEMARSE, WILLIAM ROBEY III Prescribing Physician Assistant Physician Assistant 9101285 11/15/2023
DOLAN, NICHOLAS ALEXANDER Prescribing Physician Assistant Physician Assistant 9113623 11/15/2023
EVANGELISTI, MINDY Prescribing Physician Assistant Physician Assistant 9118901 7/9/2024
FELDMAN, TRAVIS SCOTT Prescribing Physician Assistant Physician Assistant 9110309 11/15/2023
FERNANDEZ, FRANKLIN JOSE Prescribing Physician Assistant Physician Assistant 9117044 11/15/2023
FODERA, FRANK ANTHONY Prescribing Physician Assistant Physician Assistant 9117300 11/15/2023
FREEMAN, KELLIE CHRISTINE Prescribing Physician Assistant Physician Assistant 9110742 2/22/2024
GLEAVES, RACHEL Prescribing Physician Assistant Physician Assistant 9117325 11/15/2023
HAGEWOOD, STEVEN STALLENS Prescribing Physician Assistant Physician Assistant 9110717 11/15/2023
HARDEN, KYLE Prescribing Physician Assistant Physician Assistant 9113509 11/15/2023
HAVERCHAK, ALEXANDRA Prescribing Physician Assistant Physician Assistant 9115748 11/15/2023
HOLLIS, GREG DWIGHT Prescribing Physician Assistant Physician Assistant 9106026 11/15/2023
HUGNEY, DANIELLE NICOLE Prescribing Physician Assistant Physician Assistant 9117466 11/15/2023
JOHNSON, HEATHER ANNE Prescribing Physician Assistant Physician Assistant 3023 11/15/2023
JONES, LINDSEY GAIL Prescribing Physician Assistant Physician Assistant 9114709 11/15/2023
KAZAR, JAMIE LYNN Prescribing Physician Assistant Physician Assistant 9117682 11/15/2023
KHURRAM, SEHRISH Prescribing Physician Assistant Physician Assistant 9118360 8/1/2024
KIMMERLING, ADAM TYLER Prescribing Physician Assistant Physician Assistant 9108682 11/15/2023
KINSEY, RICHARD RAYMOND JR Prescribing Physician Assistant Physician Assistant 9101145 11/15/2023
KNOTEN, LAUREN Prescribing Physician Assistant Physician Assistant 9110039 11/15/2023
KOKJOHN, KRISTEN LYNN Prescribing Physician Assistant Physician Assistant 9116466 11/15/2023
KUPKE, WILLIAM ROBERT Prescribing Physician Assistant Physician Assistant 9113667 11/15/2023
LANCASTER, CHRISTOPHER ALEXANDER Prescribing Physician Assistant Physician Assistant 9104840 11/15/2023
LARIMORE, TRAVIS LEE Prescribing Physician Assistant Physician Assistant 9106146 11/15/2023
LAVINA, JAY PATRICK Prescribing Physician Assistant Physician Assistant 9102410 11/15/2023
LIVOTI, REINALDO Prescribing Physician Assistant Physician Assistant 9118153 11/15/2023
LUDWIG, RICHARD EUGENE Prescribing Physician Assistant Physician Assistant 9102456 11/15/2023
LYNCH, KATIE Prescribing Physician Assistant Physician Assistant 9110528 11/15/2023
MADDALONI, ANGELINA Prescribing Physician Assistant Physician Assistant 9115757 11/15/2023
MAFFEO, HEATHER NICOLE Prescribing Physician Assistant Physician Assistant 9117673 11/15/2023
MASTERSON, KELSEY ANN Prescribing Physician Assistant Physician Assistant 9111251 11/15/2023
MONROE, BRADLEY SEAN Prescribing Physician Assistant Physician Assistant 9115248 11/15/2023
MUTZ, DANIEL ADAM Prescribing Physician Assistant Physician Assistant 9117071 11/15/2023
NICHOLS, ALEXANDER CARL Prescribing Physician Assistant Physician Assistant 9117561 11/15/2023
NUNEZ-CUBILLAS, ALBERTO Prescribing Physician Assistant Physician Assistant 9101680 11/15/2023
PABST II, DAVID J Prescribing Physician Assistant Physician Assistant 9117468 11/15/2023
PARKS, THOMAS EDWARD Prescribing Physician Assistant Physician Assistant 9105210 11/15/2023
PASHEGOBA, STEVEN LEE Prescribing Physician Assistant Physician Assistant 9101722 11/15/2023
PELLISSIER, OLIVIA MARIE Prescribing Physician Assistant Physician Assistant 9118062 11/15/2023
PERRY, ALYSSA ANN Prescribing Physician Assistant Physician Assistant 9107106 11/15/2023
REEVES, TRAVIS LANCE Prescribing Physician Assistant Physician Assistant 9110296 11/15/2023
RESTREPO, GLISET Prescribing Physician Assistant Physician Assistant 9110146 11/15/2023
RINI, JACLYN Prescribing Physician Assistant Physician Assistant 9108634 11/15/2023
RIZZO, MARISSA Prescribing Physician Assistant Physician Assistant 9114944 11/15/2023
SANCHEZ, DANIELA Prescribing Physician Assistant Physician Assistant 9117523 11/15/2023
SCHLEIF, ROBERT DAVID Prescribing Physician Assistant Physician Assistant 9112559 11/15/2023
SCOTT, MATTHEW ALEXANDER Prescribing Physician Assistant Physician Assistant 9106407 11/15/2023
SKIDMORE, JUSTIN STUART Prescribing Physician Assistant Physician Assistant 9110082 11/15/2023
SMITH, IMELDA Prescribing Physician Assistant Physician Assistant 9115912 11/15/2023
SORDAN, MICHAEL ROLF Prescribing Physician Assistant Physician Assistant 9115648 11/15/2023
STINEBECK, JARED C Prescribing Physician Assistant Physician Assistant 9105546 11/15/2023
SUCKOW, WENDY SUE Prescribing Physician Assistant Physician Assistant 9101731 11/15/2023
SUSSMAN, MICHAEL LORNE Prescribing Physician Assistant Physician Assistant 9107280 11/15/2023
TINGLER, TARA LYNN Prescribing Physician Assistant Physician Assistant 9102755 11/15/2023
WANZER, ASHLEY Prescribing Physician Assistant Physician Assistant 9112753 11/15/2023
WATTERS, JOSEPH Prescribing Physician Assistant Physician Assistant 9112435 11/15/2023
WEAVER, LEAH DARE Prescribing Physician Assistant Physician Assistant 9103804 11/15/2023
WILSON, NANCY JOANN Prescribing Physician Assistant Physician Assistant 9105925 11/15/2023
YEH, ANDERSON Prescribing Physician Assistant Physician Assistant 9113431 11/15/2023

Click on the License Number to view License Details for that Practitioner

Name Relationship Profession License Effective Date

Click on the License Number to view License Details for that Practitioner



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.