License Verification

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SAMUEL GORDON HATHCOCK

License Number: PA9116218

Data As Of 5/10/2025

Profession
Physician Assistant
License
PA9116218
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
07/22/2022
Address of Record
400 Celebration Pl
CELEBRATION, FL 34747
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
Yes
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date
BARB, ILIE TOMA Supervising Prescribing Practitioner Medical Doctor 112264 01/16/2024
CAPUTO, CHRISTOPHER PATRICK Supervising Prescribing Practitioner Osteopathic Physician 8929 01/16/2024
CHAUFFE, RYAN Supervising Prescribing Practitioner Osteopathic Physician 18319 01/16/2024
CROUSHORE, ELMER ELLSWORTH Supervising Prescribing Practitioner Medical Doctor 58091 01/16/2024
ESTEL, CHRISTOPHER ERIC Supervising Prescribing Practitioner Medical Doctor 137098 01/16/2024
JANSEN, MICHAEL JOSEPH Supervising Prescribing Practitioner Medical Doctor 115185 01/16/2024
KHUDDUS, MATHEEN AHMED Supervising Prescribing Practitioner Medical Doctor 88697 01/16/2024
KOONS, JAY CLYDE Supervising Prescribing Practitioner Medical Doctor 55736 01/16/2024
LEE, ARTHUR CHANG YOUNG Supervising Prescribing Practitioner Medical Doctor 90119 01/16/2024
NAWAZ, NASIR Supervising Prescribing Practitioner Medical Doctor 145044 01/16/2024
O'MEARA, JAMES JOSEPH III Supervising Prescribing Practitioner Medical Doctor 70431 01/16/2024
ORTIZ, FERNANDO Supervising Prescribing Practitioner Medical Doctor 150450 01/16/2024
PONDICHERRY-HARISH, ROJA CHANDRASHEKHAR Supervising Prescribing Practitioner Medical Doctor 136583 01/16/2024
SMOCK, ANDREW LAWRENCE Supervising Prescribing Practitioner Medical Doctor 69600 01/16/2024
SUBRAMANIAN, NATRAJAN RAJ Supervising Prescribing Practitioner Medical Doctor 104225 01/16/2024
TONG, ANN TRUONG Supervising Prescribing Practitioner Medical Doctor 105109 01/16/2024
TULLI, MARK ANTHONY Supervising Prescribing Practitioner Medical Doctor 96062 01/16/2024
VAN ROY, DANIEL Supervising Prescribing Practitioner Medical Doctor 77995 01/16/2024
WESSEL, TIMOTHY RAY Supervising Prescribing Practitioner Medical Doctor 85153 01/04/2023
ZENTKO, SUZANNE ELIZABETH Supervising Prescribing Practitioner Medical Doctor 108005 01/16/2024

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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 5/11/2025



* 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.