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GCMB Approved Emergency Practice Permit/ Temp License 2020

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GCMB Approved Emergency Practice Permit/ Temp License 2020 GCMB Approved Emergency Practice Permit/ Temp License 2020 EPP ID# Approved Expires O Full_Name Profession Address_line 1 City State Zip Code 2 3/23/2020 8/11/2020 Brian David Quint MD 586 Bothwell Drive Richmond Hill GA 31324 3 4/30/2020 8/11/2020 Mark E Franke MD 13422 Black Gum Ct Chantilly VA 20151 4 4/30/2020 8/11/2020 Ashley Noelle Davis MD 293 Deering Road NW Atlanta GA 30309 5 4/30/2020 8/11/2020 Tonja L. Gadsden MD 10817 Legend Manor Lane Glenn Dale MD 20769 6 4/30/2020 8/11/2020 Erin Kim APRN 155 South Court Avenue Orlando FL 32801 7 4/30/2020 8/11/2020 Kyle Ward APRN 7800 Freestyle Lane Winter Garden FL 34787 8 4/30/2020 8/11/2020 Mary E. Carrigan APRN 701 15th Ave S. Jax Beach FL 32250 9 4/30/2020 8/11/2020 Christine Thorogood MD 916 E. Pleasant Pl. St. Johns FL 32259 10 4/30/2020 8/11/2020 Courtney Allison Bryant Whatley RCP 98 N. Charity Lane Warner Robins GA 31088 11 4/30/2020 8/11/2020 Julia Tuyet Vu MD 105 Longwood Drive Jonesboro GA 30236 12 4/30/2020 8/11/2020 Susamma George Nathew MD 3525 Sugarloaf Parkway Lawrenceville GA 30044 13 4/30/2020 8/11/2020 Magdy Nassif Falstiny MD 1257 SW 87th PL Ocala FL 34476 14 4/30/2020 8/11/2020 Kirby Douglas Slifer DO 2554 Walker Drive Valparaiso IN 46385 15 4/30/2020 8/11/2020 Roy Niels Skousen DO 2112 Cooperfield Stillwater OK 74074 16 4/30/2020 8/11/2020 John Silver, MD, FCCP MD 810 East Pine Street Stayton OR 97383 17 4/30/2020 8/11/2020 Tiffany Best MD 3300 N. 7th Avenue Phoenix AZ 85013 06-Jul-20 Page 1 of 50 EPP ID# Approved Expires O Full_Name Profession Address_line 1 City State Zip Code 18 4/30/2020 8/11/2020 Ravikumar Patel DO 104 Chamblee Blvd. Greenville SC 29615 19 4/30/2020 8/11/2020 LaTania Michelle Akers-White, MD MD 512 Besler Lane Richmond VA 23223 20 4/30/2020 8/11/2020 Asha Zakiya Robinson-Parks, MD MD 5137 Sorrento Blvd. W. St. Cloud FL 344771 21 4/30/2020 8/11/2020 Heidi Ann Morris, DO DO 5317 Sanctuary Lane Sheffield village OH 44054 22 4/30/2020 8/11/2020 Peter John Vasquez MD 18427 N. Madison Road Maricopa AZ 85139 23 4/30/2020 8/11/2020 Nathaniel Morin DO 785 32nd Street Boulder CO 80303 24 4/30/2020 8/11/2020 Nicola Mario Zetola MD 3610 Dillon Street Baltimore MD 21224 25 4/30/2020 8/11/2020 Laura Gunder McClary PA 4245 Anderson Circle Evans GA 30809 26 4/30/2020 8/11/2020 Robert Harrell Martin, Jr. MD 1464 South 16th Section Road Monticello AR 71655 27 4/30/2020 8/11/2020 Tuesday Cunningham APRN 10733 Cambbage Tree Loop Orlando FL 32825 28 4/30/2020 8/11/2020 Cam Wagner APRN 401 E. Fairbanks Avenue Winter Park FL 32789 29 4/30/2020 8/11/2020 Eric Palmer APRN 6405 Diane Ct. St. Cloud FL 34771 30 4/30/2020 8/11/2020 Deborah Messier APRN 6362 Sedona Leaf Court Windermere FL 34786 31 4/30/2020 8/11/2020 Sharron McDonald APRN 8408 Diamond Cove Cr. Orlando FL 32838 32 4/30/2020 8/11/2020 Paula Vasquez APRN 1024 Girard Drive Orlando FL 32824 33 4/30/2020 8/11/2020 Heather Elizabeth Henry MD 905 20th Avenue S Nashville TN 37203 34 4/30/2020 8/11/2020 Lynne M. Evoy APRN 14975 Fern Hammock Drive NorthJacksonville FL 32258 35 3/24/2020 8/11/2020 Pamela J. Parsons MD Premier Psychiatric Services, LLCBaton Rouge LA 70816 36 3/26/2020 8/11/2020 Annette Wilson PA 3034 Fermanagh Dr. Tallahassee FL 32309 06-Jul-20 Page 2 of 50 EPP ID# Approved Expires O Full_Name Profession Address_line 1 City State Zip Code 37 3/26/2020 8/11/2020 Meeredith Ann Stasi PA 7871 Kiverton Place Atlanta GA 30350-588 38 3/26/2020 8/11/2020 Keyanna Monique Williams PA 3505 Cobblestone Blvd. Fayetteville GA 30215 39 3/26/2020 8/11/2020 Heather Ann Lewis Prusik PA 2638 Rangewood Drive Atlanta GA 30345 40 3/26/2020 8/11/2020 Brian Michael Free RCP 75 Rosewood Lane Young Harris GA 30582 41 3/26/2020 8/11/2020 Mark Ivo Kaminski MD 345 E 54th Street New York NY 10022 42 3/26/2020 8/11/2020 John R. Langefeld MD 2246 Vinings CV SE Smyrna GA 30080 43 3/26/2020 8/11/2020 Nicholas Wisnoski MD 154 E 29th Street New York NY 10016 44 3/26/2020 8/11/2020 Amy M. Korn-Reavis RCP 9573 Turkey Oak Bend Orlando FL 32817 45 3/26/2020 8/11/2020 Miri W. Rosen MD 1751 Second Avenue New York NY 10128 46 3/26/2020 8/11/2020 Jonathan Ohenhen MD 921 W. 11th Street Sulphur OK 73086 47 3/26/2020 8/11/2020 Soujanya Pulluru MD 3908 Littlestone Circle Naperville IL 60564 48 3/26/2020 8/11/2020 Tiffani L. Bell MD 6182 Barrington Oaks Dr. Clemmons NC 27012 49 3/26/2020 8/11/2020 Janet Marie Warrington DO 5533 Superior Dr. Lakeland FL 33805 50 3/26/2020 8/11/2020 Kairul Steven Lehardi APRN 10426 S 952 PR SE Kennewick WA 99338 51 3/26/2020 8/11/2020 Steven Arthur Rabin MD 10061 Riverside Dr. Toluca Lake CA 91602 52 3/26/2020 8/11/2020 Tiandra LaShay Quiller RCP 26 Cross Pointe Greenville SC 29607 53 3/30/2020 8/11/2020 Marjorie Lantum MD 333 Cedarcreek Drive Nashville TN 37211 54 3/30/2020 8/11/2020 Heidi Hansen Ashbaugh MD 841 Prudential Drive Jacksonville FL 32207 55 3/30/2020 8/11/2020 Dustin Huntington Brimblecom MD 841 Prudential Drive Jaconsonville FL 32207 06-Jul-20 Page 3 of 50 EPP ID# Approved Expires O Full_Name Profession Address_line 1 City State Zip Code 56 3/30/2020 8/11/2020 Karah Lynn Brown PA 11395 Old Post Road Hortense GA 31543 57 3/30/2020 8/11/2020 Dantae L. Bowie DO 14 Meadow Valley Court Midland GA 31820 58 3/30/2020 8/11/2020 Marcelo Carlos Darabos DO 841 Prudential Drive Jacksonville FL 32207 59 3/30/2020 8/11/2020 Jasmine Renay Dillard APRN 1401 Centerville Road Tallahassee FL 32308 60 3/30/2020 8/11/2020 David Jerry Dixon DO 1401 Centerville Road Tallahassee FL 32308 61 3/30/2020 8/11/2020 Alexander Dumas Jesse Brickler, III MD 1401 Centerville Road Tallahassee FL 32308 62 3/30/2020 8/11/2020 Erin Michaele Ferguson PA 7304 Gracemont Lane Brunswick GA 31525 63 3/30/2020 8/11/2020 Darrell Wayne Fixler Jr. RCP 178 Somersby Blvd. Pooler GA 31322 64 3/30/2020 8/11/2020 Andrea King Friall MD 1401 Centerville Road Tallahassee FL 32308 65 3/28/2020 8/11/2020 Christopher Joseph Gasho MD 52 Ivy Lane Santa Rosa Beach FL 32459 66 3/30/2020 8/11/2020 Joseph P. Grajo DO 461 Ron Horse Lane Walnut Creek CA 94597 67 3/30/2020 8/11/2020 Candice Priscilla Gregg APRN 1401 Centerville Road Tallahassee FL 32308 68 3/30/2020 8/11/2020 Laura J. Grippa MD 841 Prudential Drive Jacksonville FL 32207 69 3/30/2020 8/11/2020 Francisco Javier Gutierrez DO 841 Prudential Drive Suite 1400 FL 32207 70 3/30/2020 8/11/2020 Amy Marlo Haddock MD 1401 Centerville Road Tallahassee FL 32308 71 3/30/2020 8/11/2020 Stella Marie Hayes MD 841 Prudential Drive, Jacksonville FL 32201 72 3/30/2020 8/11/2020 Smruti J. Kinariwala MD 95002 Buckeye Court Fernandine Beach FL 65267 73 3/30/2020 8/11/2020 Jeffrey Ling Kang MD 147 Royal Palm Drive Fort Lauderdale FL 33301 74 3/30/2020 8/11/2020 Sajid Khan MD 1040 SW 2nd Ave Ocala FL 34471 06-Jul-20 Page 4 of 50 EPP ID# Approved Expires O Full_Name Profession Address_line 1 City State Zip Code 75 3/30/2020 8/11/2020 Joseph Mark King MD 841 Prudential Drive Jacksonville FL 32207 76 3/30/2020 7/20/2020 Kendra Wooley Marcinowski APRN 1401 Centerville Road Tallahassee FL 32308 77 3/30/2020 8/11/2020 Kenneth John McAlpine MD 1401 Centerville Road Tallahassee FL 32308 78 3/30/2020 8/11/2020 Sean F. McGrath MD 841 Prudential Drive Jacksonville FL 32207 79 3/30/2020 8/11/2020 Vikki Margaret McKinnie MD 1401 Centerville Road Tallahassee FL 32308 80 3/30/2020 8/11/2020 Rajasree Nambron MD 157 Birch Creek Drive Birmingham AL 35242 81 3/30/2020 8/11/2020 Lemuel Pierre PA 10842 Blue Palm Street Plantation FL 33324 82 3/30/2020 8/11/2020 Steven Arthur Rabin MD 10061 Riverside Drive Toluca Lake CA 91602 83 3/30/2020 8/11/2020 Gurijala Ramesh Ramayya MD 215 Autumn Trace Court Macon GA 31210 84 3/30/2020 8/11/2020 Kathleen Elizabeth Sharp MD 2943 Bandera Grand Prairie TX 75054 85 3/30/2020 8/11/2020 Anne-Marie Lewis Singleton APRN 1401 Centerville Road Tallahassee FL 32308 86 3/30/2020 8/11/2020 Kelley Lynn Stem PA 1401 Centerville Road Tallahassee FL 32308 87 3/30/2020 8/11/2020 Christopher Charles Sundstrom MD 1401 Centerville Road Tallahassee FL 32308 88 3/30/2020 8/11/2020 Briana Nicole Thompson MD 1401 Centerville Road Tallahassee FL 32308 89 3/30/2020 8/11/2020 Erin Roberts Thames APRN 1401 Centerville Road Tallahassee FL 32308 90 3/30/2020 8/11/2020 Courtney Blair Fahnhorst Vidrine MD 841 Prudential Drive Jacksonville FL 32207 91 3/30/2020 8/11/2020 Frank J.
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