License Verification

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KIMBERLY MATTSON WIERINGA

License Number: PA9105525

Data As Of 12/2/2024

Profession
Physician Assistant
License
PA9105525
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
07/08/2010
Address of Record
1633 RACETRACK RD
SUITE 101
SAINT JOHNS, FL 32259
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
Yes
Discipline on File
No
Public Complaint
No
Address
9580 Applecross Rd #106
JACKSONVILLE, FL 32222
Address
4160 Southside Blvd #10
JACKSONVILLE, FL 32216
Address
30 Epic Blvd #100 Avecina Medical
ST AUGUSTINE, FL 32086
Address
105 Badger Park Dr Suite 8
SAINT JOHNS, FL 32259
Address
30 Epic Blvd Ste 100
ST AUGUSTINE, FL 32086
Name Relationship Profession License Effective Date
COWART, JENNIFER BROOKE MD Supervising Prescribing Practitioner Medical Doctor 126831 07/01/2020
COWDELL, JED COLT Supervising Prescribing Practitioner Medical Doctor 125749 06/30/2020
DAWSON, NANCY LEE MD Supervising Prescribing Practitioner Medical Doctor 83319 06/29/2020
DUMITRASCU, ADRIAN GEORGE Supervising Prescribing Practitioner Medical Doctor 106243 06/30/2020
EDWARDS, ERIC Supervising Prescribing Practitioner Medical Doctor 137916 06/29/2020
GARLAND, JEFFREY LEWIS Supervising Prescribing Practitioner Medical Doctor 82064 06/27/2020
GNANAPANDITHAN, KARTHIK Supervising Prescribing Practitioner Medical Doctor 143050 07/07/2020
HERRIGEL, DANA JOY Supervising Prescribing Practitioner Medical Doctor 128085 07/20/2020
HILL, EBONE DANIELLE Supervising Prescribing Practitioner Medical Doctor 107304 06/23/2020
HUSSAIN, MOHAMMAD TAHIR Supervising Prescribing Practitioner Medical Doctor 137887 06/23/2020
JOYCE, NICOLE ELIZABETH Supervising Prescribing Practitioner Medical Doctor 128255 07/07/2020
MANIACI, MICHAEL JOSEPH Supervising Prescribing Practitioner Medical Doctor 90754 06/26/2020
MATCHA, GAUTAM VIVEK Supervising Prescribing Practitioner Medical Doctor 118355 06/23/2020
MCKINNEY, MARGARET EDGINGTON Supervising Prescribing Practitioner Medical Doctor 121734 06/23/2020
MODEL, DMITRIY BORISOVICH Supervising Prescribing Practitioner Medical Doctor 88320 05/31/2017
MORAN, KAITLIN MCCURDY Supervising Prescribing Practitioner Medical Doctor 123359 07/20/2020
PAGAN, RICARDO J Supervising Prescribing Practitioner Medical Doctor 114300 06/23/2020
PRITCHARD, INGRID JULIETTE Supervising Prescribing Practitioner Medical Doctor 90557 06/23/2020
ROY, ARCHANA Supervising Prescribing Practitioner Medical Doctor 82081 06/23/2020
SAFER, LESLIE F Supervising Prescribing Practitioner Medical Doctor 86800 06/29/2020
SEIM, LYNSEY ANN Supervising Prescribing Practitioner Medical Doctor 102457 06/23/2020
SMERINA, MICHAEL Supervising Prescribing Practitioner Medical Doctor 132604 06/26/2020
SOLEYMANI, SAMAN Supervising Prescribing Practitioner Medical Doctor 88018 05/31/2017
TRAUTMAN, CHRISTOPHER LEE Supervising Prescribing Practitioner Medical Doctor 124952 07/07/2020
VIJAPURA, PRIYANKA Supervising Prescribing Practitioner Medical Doctor 130078 06/27/2020

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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.


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.