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EDIL J AGOSTO DIAZ

License Number: ME102761

Data As Of 5/16/2024

Profession
Medical Doctor
License
ME102761
License Status
CLEAR/Active
Qualifications
Dispensing Practitioner
License Expiration Date
1/31/2025
License Original Issue Date
09/09/2008
Address of Record
1775 W HIBISCUS BLVD SUITE 215
MELBOURNE, FL 32901
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
Yes
Yes
Discipline on File
No
Public Complaint
No
Address
117 N. 5th St. Ste #5
FORT PIERCE, FL 34950
Name Relationship Profession License Effective Date
DEVAUX, MIKAELA ELISE Supervisor Medical Doctor 130853 05/24/2021
HEIST, DORAN ROBERT MD Supervisor Medical Doctor 111822 05/24/2021
MCGOOHAN, MICHAEL PATRICK DO Supervisor Osteopathic Physician 6325 05/24/2021
RAMAGE, DARRON TRAVIS Supervisor Medical Doctor 115024 05/24/2021

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Name Relationship Profession License Effective Date
ANDERSON, SHERRI MADRID Prescribing Physician Assistant Physician Assistant 9105823 10/26/2022
BIGGS, FREDERICK SCOTT Prescribing Physician Assistant Physician Assistant 9103660 11/1/2022
BO, KIRSTEN LEIGH Prescribing Physician Assistant Physician Assistant 9104713 11/1/2022
BOWMAN, KELLEY FRANCES Prescribing Physician Assistant Physician Assistant 9104618 11/1/2022
CALLAHAN, KYLE JONATHAN Prescribing Physician Assistant Physician Assistant 9109286 5/5/2016
COLON CRUZ, EDDID DAVID Prescribing Physician Assistant Medical Doctor 120690 2/28/2021
FREDERIQUE-BELL, PEGGY Prescribing Physician Assistant Physician Assistant 9101972 10/26/2022
GILROY, RONALD THOMAS MD Prescribing Physician Assistant Medical Doctor 61905 12/1/2022
GRAHAM-LEVY, HALCIAN L Prescribing Physician Assistant Physician Assistant 9103552 11/1/2022
HAGLER, SARA VIRGINIA Prescribing Physician Assistant Physician Assistant 9103008 11/1/2022
HASENAUER, KRISTOPHER SHANE Prescribing Physician Assistant Physician Assistant 9108369 11/1/2022
JOCKOVICH, MILAN MD Subordinate Medical Doctor 65559 3/5/2021
LONG, KAYLA Prescribing Physician Assistant Physician Assistant 9115180 11/1/2022
MATEY, JENNIFER LYNN Prescribing Physician Assistant Physician Assistant 9108982 8/31/2023
MEGREGIAN, LINDSEY MARKS Prescribing Physician Assistant Physician Assistant 9106660 11/1/2022
MICHAELMAN, GWENDOLYN BRUCH Prescribing Physician Assistant Physician Assistant 9104166 11/1/2022
NIMETH, MARTINA MARIE Prescribing Physician Assistant Physician Assistant 9102555 2/28/2021
PETERSON, JAYME MICHELLE Prescribing Physician Assistant Physician Assistant 9103306 11/1/2022
RODRIGUEZ, SUSELY CAROLINA Prescribing Physician Assistant Physician Assistant 9115448 10/6/2022
SANDER, ANDREW THOMAS Prescribing Physician Assistant Physician Assistant 9104502 11/1/2022
SCULLY, KYLE Prescribing Physician Assistant Physician Assistant 9111560 4/15/2020
SMITH, COREY THOMAS Prescribing Physician Assistant Physician Assistant 9108381 5/19/2016
TURK, ADAM SCOTT Prescribing Physician Assistant Physician Assistant 9106810 11/1/2022
VAN HEMEL, ELIZABETH ANNE Prescribing Physician Assistant Physician Assistant 3575 10/26/2022
VEGA, JOSE' M Prescribing Physician Assistant Physician Assistant 2245 11/1/2022

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Name Relationship Profession License Effective Date

Click on the License Number to view License Details for that Practitioner



No Continuing Education Hours Received from Approved Providers As Of 5/16/2024



* 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.