License Verification

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JORDAN AUSTIN STORES

License Number: PA9113597

Data As Of 12/2/2024

Profession
Physician Assistant
License
PA9113597
License Status
CLEAR/Active
Qualifications
Dispensing Practitioner
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
09/21/2020
Address of Record
ER 1670 St. Vincents Way
Middleburg, FL
32068
MIDDLEBURG, FL 32068
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
ER 1 Shircliff Way Jacksonville, FL 32204
JACKSONVILLE, FL 32204
Address
ER 4201 Belfort Road Jacksonville, FL 32216
JACKSONVILLE, FL 32216
Name Relationship Profession License Effective Date
BRYANT, LAURIE SUSAN Supervising Prescribing Practitioner Osteopathic Physician 13282 11/12/2024
PEREZ-GARCIA, MARIA DEL CARMEN M D Supervising Dispensing Practitioner Medical Doctor 109778 07/12/2021
PEREZ-GARCIA, MARIA DEL CARMEN M D Supervising Prescribing Practitioner Medical Doctor 109778 07/12/2021

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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



* 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.


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