License Verification

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NHI NGOC DAI

License Number: PA9114140

Data As Of 12/4/2024

Profession
Physician Assistant
License
PA9114140
License Status
CLEAR/Active
Qualifications
Prescribing
Dispensing Practitioner
License Expiration Date
1/31/2026
License Original Issue Date
02/24/2021
Address of Record
3930 Howard Hughes Parkway
suite 270
LAS VEGAS, NV 89169
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
2020 Main Street Sarasota county Jail
SARASOTA, FL 34237
Address
14470 Harlee Road Manatee County Jail
PALMETTO, FL 34221
Name Relationship Profession License Effective Date
TIESZEN, STUART CARL Supervising Dispensing Practitioner Medical Doctor 147757 10/01/2021
TIESZEN, STUART CARL Supervising Prescribing Practitioner Medical Doctor 147757 02/26/2021
WADE, ELLIOT LOUIS Supervising Prescribing Practitioner Medical Doctor 146732 09/29/2021

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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 12/4/2024



* 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.