License Verification

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PUSHPAL R. BANERJEE

License Number: OS8141

Data As Of 12/2/2024

Profession
Osteopathic Physician
License
OS8141
License Status
CLEAR/Active
Qualifications
Dispensing Practitioner
License Expiration Date
3/31/2026
License Original Issue Date
05/18/2000
Address of Record
2470 CLOWER LANE
BARTOW, FL 33831
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
Yes
Discipline on File
No
Public Complaint
No
Address
2650 WEST STATE RD 434 EXPRESS CARE CLINIC
LONGWOOD, FL 32779
Address
1201 Cypress Parkway Poinciana
POINCIANA, FL 34759
Address
5201 Cornell St.
LAKELAND, FL 33809
Address
911 S Woodrow Wilson UNIT 23
PLANT CITY, FL 33563
Name Relationship Profession License Effective Date
BALLARD, PATRICK Supervising Prescribing Practitioner Osteopathic Physician 20852 06/12/2024
GLAZER, KELLY SYLVIA Supervising Prescribing Practitioner Medical Doctor 149363 08/13/2021
LIPSMEYER, CHRISTOPHER PAUL Supervisor Medical Doctor 102475 08/08/2020
PATEL, SUMIT SUNIL Supervisor Medical Doctor 135844 11/01/2020
TANA, CHRISTOPHER FRANK Supervising Prescribing Practitioner Osteopathic Physician 10435 06/13/2023

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Name Relationship Profession License Effective Date
BAILEY-STULTZ, MAROLDA P Prescribing Physician Assistant Physician Assistant 2031 8/1/2021
BIGGS, FREDERICK SCOTT Prescribing Physician Assistant Physician Assistant 9103660 8/16/2021
BLANKENSHIP, COURTNEY ANN Prescribing Physician Assistant Physician Assistant 9106490 8/1/2021
COVITZ, SHANNON MIXON Prescribing Physician Assistant Osteopathic Physician 11652 8/1/2021
EMS TEAM LLC Service Provider EMS Service Provider ALS 10065 5/30/2023
ENNIS, ELIZABETH MARGARET PA-C Prescribing Physician Assistant Physician Assistant 9105563 4/27/2017
EVERSOLE, KRISTEN SUSSANNE Prescribing Physician Assistant Physician Assistant 9103496 8/1/2021
GILLESPIE, RITA MARGARET MARY Prescribing Physician Assistant Osteopathic Physician 13077 8/1/2021
GREENE, RICHARD MICHAEL Prescribing Physician Assistant Physician Assistant 9106015 8/16/2021
HAMIL, JUSTIN Prescribing Physician Assistant Physician Assistant 9115544 2/19/2023
HAMILTON, CARLTON CARMICHAEL II Subordinate Medical Doctor 87840 3/1/2020
HULTZ, CINTIA HENRIQUES Prescribing Physician Assistant Physician Assistant 9109327 4/1/2022
JOHNSON, IAN JAMES Prescribing Physician Assistant Physician Assistant 9110730 2/2/2023
LAM, BETHANY-BINH KIET Prescribing Physician Assistant Physician Assistant 9103894 8/1/2021
LEKAVICH, THOMAS ALEXANDER Prescribing Physician Assistant Physician Assistant 9102189 6/12/2023
MARTIN, SAMANTHA LEIGH Prescribing Physician Assistant Physician Assistant 9113333 8/1/2021
MITCHELL, CRAIG ROBERT MD Subordinate Medical Doctor 102920 2/26/2021
MOODY, NANCY C Prescribing Physician Assistant Physician Assistant 2377 8/1/2021
NOTMAN, BRITTANY RENEE Prescribing Physician Assistant Physician Assistant 9107171 8/16/2021
NUNEZ-CUBILLAS, ALBERTO Prescribing Physician Assistant Physician Assistant 9101680 8/16/2021
OLIVA, JOSEPH WAYNE Subordinate Osteopathic Physician 10074 6/1/2021
POLK COUNTY BOARD OF COUNTY COMMISSIONER Service Provider EMS Service Provider ALS 5302 2/11/2014
SERVIAM GROUP LLC Service Provider EMS Service Provider BLS 9009 10/31/2023
SPENCER, ANDREW JOSEPH Prescribing Physician Assistant Medical Doctor 122767 8/1/2021
THOMPSON, SARA Prescribing Physician Assistant Physician Assistant 9108278 8/16/2021
VOGT, JASON M Prescribing Physician Assistant Physician Assistant 9107868 8/16/2021

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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.


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.