License Verification

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LAUREN BROOKE WIDNER

License Number: PA9105907

Data As Of 12/2/2024

Profession
Physician Assistant
License
PA9105907
License Status
DELINQUENT/
Qualifications
Prescribing
Dispensing Practitioner
License Expiration Date
1/31/2024
License Original Issue Date
02/02/2011
Address of Record
5301 N Central Ave
TAMPA, FL 33603
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
2600 BRUCE B. DOWNS BLVD. FLORIDA HOSPITAL WESLEY CHAPEL
WESLEY CHAPEL, FL 33544
Address
7171 N DALE MABRY HIGHWAY FLORIDA HOSPITAL CARROLLWOOD
TAMPA, FL 33617
Address
16625 STATE ROAD 54 FLORIDA HOSPITAL CENTRAL PASCO ER.
LUTZ, FL 33558
Name Relationship Profession License Effective Date
CHRISTIANO, DANIELLE MARIE Supervising Prescribing Practitioner Medical Doctor 98327 03/16/2016
DEGROAT, JONATHAN THOMAS Supervising Prescribing Practitioner Medical Doctor 114356 03/16/2016
DESAI, AJAY Supervising Prescribing Practitioner Osteopathic Physician 12568 03/16/2016
DUBEY, JESSE VINCENT Supervising Prescribing Practitioner Osteopathic Physician 13099 08/05/2016
HENDRIX, TIMOTHY WAYNE Supervising Dispensing Practitioner Medical Doctor 65142 08/01/2021
HUMMEL, LAURA Supervising Prescribing Practitioner Medical Doctor 127881 08/05/2016
KOONKITTI, PARICHART CANDY Supervising Prescribing Practitioner Medical Doctor 125284 03/16/2016
NESSELROADE, RYAN DAVID Supervising Prescribing Practitioner Medical Doctor 106189 03/16/2016
OSBORNE, AARON RYAN Supervising Prescribing Practitioner Medical Doctor 108215 03/16/2016
PATEL, TEJAS Supervising Prescribing Practitioner Osteopathic Physician 13790 08/05/2016
SECREST, JULIE K Supervising Prescribing Practitioner Medical Doctor 110718 03/16/2016
SHAH, MANASI SAMIR Supervising Prescribing Practitioner Medical Doctor 127451 08/05/2016
SLACK, KENNETH VERNON Supervising Dispensing Practitioner Medical Doctor 119973 08/10/2021
VIBHAKAR, ARJUN Supervising Prescribing Practitioner Medical Doctor 128122 08/05/2016

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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.