License Verification

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ANN VIRGINIA BROCK

License Number: PA9102723

Data As Of 10/31/2026

Profession
Physician Assistant
License
PA9102723
License Status
Clear/Active
Qualifications
Prescribing
License Expiration Date
1/31/2028
License Original Issue Date
02/03/2004
Address of Record
HEALTH PARK MEDICAL CENTER
9981 S. HEALTHPARK DRIVE
FORT MYERS, FL 33908
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
Yes
Discipline on File
No
Public Complaint
No
Address
2776 CLEVELAND AVENUE LMHS-LEE MEMORIAL HOSPITAL
FORT MYERS, FL 33901
Address
636 DEL PRADO BLVD LMHS-CAPE CORAL HOSPITAL
CAPE CORAL, FL 33990
Address
3109 Tamiami Trail #3 Charlotte Pain Management Center
PORT CHARLOTTE, FL 33952
Address
13681 Doctors Way
FORT MYERS, FL 33912
Name Relationship Profession License Effective Date
ALFARO MAGUYON, MARIA ESTELA Supervising Prescribing Practitioner Medical Doctor 135253 10/27/2026
CHALLAPALLI, RAHUL KUMAR Supervising Prescribing Practitioner Medical Doctor 105017 10/27/2026
DAS, VIJAY SOHAN Supervising Prescribing Practitioner Medical Doctor 74834 10/27/2026
DOSANI, RAZAK ABDULSATTAR Supervising Prescribing Practitioner Medical Doctor 42297 10/27/2026
FEROZ, ABUSAYEED MUHAMMAD MD Supervising Prescribing Practitioner Medical Doctor 57253 10/27/2026
GHOSH, ANJAN KUMAR Supervising Prescribing Practitioner Medical Doctor 77629 10/27/2026
HORNER, BRIAN JOHN Supervising Prescribing Practitioner Osteopathic Physician 12664 10/27/2026
HOTHEM, ZACHARY ALLEN Supervising Prescribing Practitioner Osteopathic Physician 15587 10/27/2026
HUSSAIN, REZA SAYEED Supervising Prescribing Practitioner Medical Doctor 91173 10/27/2026
KAPADIA, SHYAM NIKHIL Supervising Prescribing Practitioner Medical Doctor 126321 10/27/2026
KASIEWICZ, JAMES Supervising Prescribing Practitioner Medical Doctor 106967 10/26/2026
KHAN, JAVAAD AHMAD Supervising Prescribing Practitioner Medical Doctor 102742 10/27/2026
KOLE, MARILYN Supervising Prescribing Practitioner Medical Doctor 69317 10/27/2026
KOVACS, LOUIS A D O Supervising Prescribing Practitioner Osteopathic Physician 1417 10/27/2026
KOZYR, SERGEY Supervising Prescribing Practitioner Medical Doctor 139548 10/27/2026
LIN, DEAN DONG Supervising Prescribing Practitioner Medical Doctor 85657 10/27/2026
MEENA, RAGAI THABETNASHED Supervising Prescribing Practitioner Medical Doctor 119278 10/27/2026
NAIK, SAGAR Supervising Prescribing Practitioner Medical Doctor 108214 10/27/2026
PAMMI, SUNIL S Supervising Prescribing Practitioner Medical Doctor 94370 10/27/2026
SAINI, PARMEET SINGH Supervising Prescribing Practitioner Medical Doctor 125499 10/27/2026
TAILLON, JORDAN KRISTOFER Supervising Prescribing Practitioner Medical Doctor 128602 10/27/2026
WILCZYNSKI, STEPHEN W MD Supervising Prescribing Practitioner Medical Doctor 120344 10/27/2026

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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 10/31/2026



* 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.