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MALLORY MOODY PUTNAM

License Number: PA9106745

Data As Of 9/7/2026

Profession
Physician Assistant
License
PA9106745
License Status
Clear/Active
Qualifications
Prescribing
License Expiration Date
1/31/2028
License Original Issue Date
08/29/2012
Address of Record
1324 Lakeland Hills Blvd
LAKELAND, FL 33805
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date
ABRAHAMSEN, NADIA Supervising Prescribing Practitioner Medical Doctor 108847 02/21/2018
AKKASHIAN, MICHAEL BERNARD Supervising Prescribing Practitioner Medical Doctor 113464 01/08/2016
ALEXANDER, LARRY LEON Supervising Prescribing Practitioner Medical Doctor 80072 07/24/2026
ALFONSO, ADALBERTO JR Supervising Prescribing Practitioner Medical Doctor 122516 01/08/2016
AMATEA, JOHN M Supervising Prescribing Practitioner Medical Doctor 111903 01/08/2016
ANCHETA, JOEY SALDANA Supervising Prescribing Practitioner Medical Doctor 72598 07/05/2017
ANDERSON, JONATHAN OSBORNE Supervising Prescribing Practitioner Medical Doctor 111888 01/08/2016
ANILUS, VESTA Supervising Prescribing Practitioner Medical Doctor 127023 07/09/2026
AREGOOD, JENNIFER JOY Supervising Prescribing Practitioner Medical Doctor 116318 02/01/2016
ARREDONDO, COREY CUMBIE Supervising Prescribing Practitioner Medical Doctor 85016 01/08/2016
BARLOW, RYAN THOMAS Supervising Prescribing Practitioner Medical Doctor 149752 07/13/2026
BATTISTINI-CHRISTIAN, JOSE FRANCISCO Supervising Prescribing Practitioner Medical Doctor 147500 07/10/2026
BEACH, KEVIN RICHARD Supervising Prescribing Practitioner Medical Doctor 107000 01/08/2016
BERMAN, RONALD Supervising Prescribing Practitioner Medical Doctor 79188 07/14/2026
BHISITKUL, DONNA MARIE Supervising Prescribing Practitioner Medical Doctor 70258 01/08/2016
BLIND, FRED JOSEPH Supervising Prescribing Practitioner Medical Doctor 99282 01/08/2016
BRAR, SARDUL SINGH MD Supervising Prescribing Practitioner Medical Doctor 48371 01/08/2016
BRENNER, ANNETTE MAGNANT Supervising Prescribing Practitioner Medical Doctor 70818 02/21/2020
BROWN, RICHARD Supervising Prescribing Practitioner Medical Doctor 132286 09/14/2017
BURKEY, MARISA LIANA Supervising Prescribing Practitioner Medical Doctor 106073 01/08/2016
BUTZ, ABRAHAM F Supervising Prescribing Practitioner Medical Doctor 102668 01/08/2016
CARMAN, MATTHEW WILLIAM Supervising Prescribing Practitioner Medical Doctor 99548 01/08/2016
CHUNG, CHARLES R Supervising Prescribing Practitioner Medical Doctor 99441 01/08/2016
COKER, PHILLIP RYAN Supervising Prescribing Practitioner Medical Doctor 122260 01/08/2016
COVITZ, SHANNON MIXON Supervising Prescribing Practitioner Osteopathic Physician 11652 02/21/2020
CUNNINGHAM, MICHAEL F Supervising Prescribing Practitioner Osteopathic Physician 14869 07/14/2026
DAMON, MARK R II Supervising Prescribing Practitioner Osteopathic Physician 21081 07/14/2026
DE LOS SANTOS, JESSE Supervising Prescribing Practitioner Medical Doctor 112913 01/08/2016
DEL VALLE, MICHAEL Supervising Prescribing Practitioner Medical Doctor 179107 07/23/2026
DELEON, JASON Supervising Prescribing Practitioner Medical Doctor 122537 02/12/2019
DUBEY, JESSE VINCENT Supervising Prescribing Practitioner Osteopathic Physician 13099 09/01/2018
ECHAGUE COLMAN, RAMON ANTONIO Supervising Prescribing Practitioner Medical Doctor 111476 07/20/2026
ESCOWITZ, HAL ETHAN Supervising Prescribing Practitioner Medical Doctor 81690 01/08/2016
FAWSETT, CHARLES ROBINSON II Supervising Prescribing Practitioner Medical Doctor 112904 01/08/2016
FERNANDEZ FERNANDEZ, JUAN RAFAEL Supervising Prescribing Practitioner Medical Doctor 127278 07/10/2026
FERNANDEZ OLIVERO, GERARDO ANDRES Supervising Prescribing Practitioner Medical Doctor 139063 07/09/2026
FISHER, ROSE MARIE Supervising Prescribing Practitioner Osteopathic Physician 6698 01/08/2016
GILLESPIE, RITA MARGARET MARY Supervising Prescribing Practitioner Osteopathic Physician 13077 02/12/2019
GLUECK, JESSE Supervising Prescribing Practitioner Medical Doctor 136392 08/09/2020
GONZALEZ-QUINTERO, ANDREA R Supervising Prescribing Practitioner Medical Doctor 141613 07/10/2026
GUGGINO, STEVEN ANTHONY MD Supervising Prescribing Practitioner Medical Doctor 83061 01/08/2016
HABER, TODD SETH Supervising Prescribing Practitioner Medical Doctor 57935 01/08/2016
HADDAD, JOE D O Supervising Prescribing Practitioner Osteopathic Physician 15867 07/14/2026
HEAD, BRIAN CHRISTOPHER Supervising Prescribing Practitioner Medical Doctor 122748 01/08/2016
JOHN, TESHY VARUGHESE Supervising Prescribing Practitioner Medical Doctor 125364 01/11/2019
KARP, JULIANA Supervising Prescribing Practitioner Medical Doctor 64823 01/08/2016
KOVALA, CHAD MICHAEL Supervising Prescribing Practitioner Osteopathic Physician 22388 07/14/2026
LALANI, FARAH NAUSHIR Supervising Prescribing Practitioner Osteopathic Physician 10814 01/08/2016
LASSETER CARMAN, MEGAN LEIGH MD Supervising Prescribing Practitioner Medical Doctor 109910 01/08/2016
LINDENBLAD, ERIC HAMILTON Supervising Prescribing Practitioner Medical Doctor 43429 01/08/2016
LONGO, JENNIFER ANN Supervising Prescribing Practitioner Medical Doctor 113332 11/04/2019
MAHON, BENJAMIN MICHAEL Supervising Prescribing Practitioner Medical Doctor 114305 07/13/2026
MARICHAL, JOSE L MD Supervising Prescribing Practitioner Medical Doctor 21830 01/08/2016
MARTINEZ, JORDAN Supervising Prescribing Practitioner Medical Doctor 168592 07/10/2026
MARTINEZ, LORENA RODRIGUEZ Supervising Prescribing Practitioner Osteopathic Physician 21064 07/23/2026
MCFARLAND, MICHAEL SCOTT Supervising Prescribing Practitioner Medical Doctor 99023 01/08/2016
MCGLINN, SEAN PATRICK D O Supervising Prescribing Practitioner Osteopathic Physician 9846 01/08/2016
MCKEE, KRISTIN CORY Supervising Prescribing Practitioner Osteopathic Physician 12083 01/08/2016
MELTON, JAMES DAVID III Supervising Prescribing Practitioner Medical Doctor 52100 01/08/2016
MEMON, SUMERA HAROON Supervising Prescribing Practitioner Osteopathic Physician 11668 07/19/2018
MIAH, BAHAR Supervising Prescribing Practitioner Medical Doctor 108183 07/10/2026
MISDARY, JOHN SARATIAL MD Supervising Prescribing Practitioner Medical Doctor 111957 06/28/2018
OLDANO, KAREN THOMAS Supervising Prescribing Practitioner Osteopathic Physician 6570 01/08/2016
OLSON, CHRISTOPHER EARL Supervising Prescribing Practitioner Medical Doctor 91253 01/08/2016
PALMA, ALEXANDER Supervising Prescribing Practitioner Medical Doctor 116475 07/09/2026
PATEL, TEJAS Supervising Prescribing Practitioner Osteopathic Physician 13790 04/19/2019
PAYOR, AUSTIN DANIEL Supervising Prescribing Practitioner Osteopathic Physician 10925 04/14/2020
PRUITT, JAMES ALLEN Supervising Prescribing Practitioner Medical Doctor 142076 07/14/2026
PYLE, JACK ROBERT Supervising Prescribing Practitioner Medical Doctor 181541 07/17/2026
REDDEN, DANYELLE ANN Supervising Prescribing Practitioner Medical Doctor 110215 01/08/2016
REEBER, CLIFF BENJAMIN Supervising Prescribing Practitioner Medical Doctor 73869 01/08/2016
REGAN, TIMOTHY JOHN Supervising Prescribing Practitioner Medical Doctor 94162 01/08/2016
REINHARDT, NEIL CHRISTOPHER Supervising Prescribing Practitioner Medical Doctor 69496 11/04/2019
RHODES, DAVID JOSEPH Supervising Prescribing Practitioner Medical Doctor 106826 01/08/2016
RODGERS, CHRISTOPHER NEILTON MD Supervising Prescribing Practitioner Medical Doctor 99231 01/08/2016
RODRIGUEZ, VASHUN APONTE Supervising Prescribing Practitioner Medical Doctor 104068 01/08/2016
ROLA, ALEXANDER Supervising Prescribing Practitioner Osteopathic Physician 8833 01/08/2016
RONDON, JUAN DIEGO Supervising Prescribing Practitioner Medical Doctor 155174 07/10/2026
ROWE, IAN RUSSELL Supervising Prescribing Practitioner Medical Doctor 112301 07/13/2026
SALAZAR, MANUEL MAURICIO Supervising Prescribing Practitioner Medical Doctor 36859 01/08/2016
SANTIAGO, RAFAEL Supervising Prescribing Practitioner Medical Doctor 90335 01/08/2016
SCHILLINGER, MATTHEW Supervising Prescribing Practitioner Osteopathic Physician 9191 01/08/2016
SELLERS, KATHERINE Supervising Prescribing Practitioner Osteopathic Physician 21108 07/13/2026
SMITH, DAVID JAMES Supervising Prescribing Practitioner Osteopathic Physician 9167 01/08/2016
SPENCER, ANDREW JOSEPH Supervising Prescribing Practitioner Medical Doctor 122767 04/19/2019
SUEN, ANDREA CATHERINE Supervising Prescribing Practitioner Medical Doctor 116964 01/11/2019
TAVORNWATTANA, JAMES Supervising Prescribing Practitioner Medical Doctor 156675 07/09/2026
TICKETT, SHELLEY SMITH Supervising Prescribing Practitioner Medical Doctor 90313 02/21/2017
TSEKHANOV, SERGEY Supervising Prescribing Practitioner Osteopathic Physician 11851 07/15/2026
VERGARA, ROBERT JOHN CRUZ Supervising Prescribing Practitioner Medical Doctor 95775 07/13/2026
VISRAM, FARID NIZARALI Supervising Prescribing Practitioner Medical Doctor 95308 01/08/2016
VU, CHRISTOPHER HUY Supervising Prescribing Practitioner Medical Doctor 109654 01/08/2016
VYTYKAC, ADAM Supervising Prescribing Practitioner Medical Doctor 115497 07/19/2018
WAN, ERIC KUO HSUAN Supervising Prescribing Practitioner Medical Doctor 92490 01/08/2016
WASHINGTON, MOSES ANTHONY Supervising Prescribing Practitioner Medical Doctor 131007 07/12/2026
WEBSTER, MAUREEN MICHELLE Supervising Prescribing Practitioner Medical Doctor 76488 01/08/2016
WEEKS, SCOTT ROBERT Supervising Prescribing Practitioner Osteopathic Physician 8388 01/08/2016
WISER, ROBERT K Supervising Prescribing Practitioner Medical Doctor 139864 02/21/2020
YICK, ANDREW VAN Supervising Prescribing Practitioner Medical Doctor 109669 01/08/2016
ZACHARIAH, ANISH BABU M D Supervising Prescribing Practitioner Medical Doctor 101413 11/04/2019

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 9/7/2026



* 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.