License Verification

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TOM WONNEBERGER

License Number: PA9112928

Data As Of 12/2/2024

Profession
Physician Assistant
License
PA9112928
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
01/14/2020
Address of Record
499 Eagle Rock Dr.
PONTE VEDRA, FL 32081
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
4201 Belfort Rd
JACKSONVILLE, FL 32216
Address
1670 ST. VINCENT'S WAY
MIDDLEBURG, FL 32068
Address
205 Tritinity Way
JACKSONVILLE, FL 32259
Address
1 SHIRCLIFF WAY
JACKSONVILLE, FL 32204
Name Relationship Profession License Effective Date
AIELLO, JAMES JOHN Supervising Prescribing Practitioner Medical Doctor 113843 04/07/2020
AUGENSTEIN, W LYNN MD Supervising Prescribing Practitioner Medical Doctor 55214 04/07/2020
BRYANT, LAURIE SUSAN Supervising Prescribing Practitioner Osteopathic Physician 13282 04/07/2020
HAROLD, KELVIN JAMES Supervising Prescribing Practitioner Medical Doctor 122392 10/25/2023
VIHLEN, ANDREW SCOTT Supervising Prescribing Practitioner Medical Doctor 109676 04/07/2020

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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.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


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