License Verification

Printer Friendly Version

SOUTHERN VASCULAR OF PANAMA CITY, LLC

License Number: OSR1524

Data As Of 5/11/2024

Profession
Office Surgery Registration
License
OSR1524
License Status
SUSPENDED/
Qualifications
any surgery w. moderate or conscious sedation
License Expiration Date
License Original Issue Date
08/28/2020
Address of Record
1399 JENKS AVE
12 / J
PANAMA CITY, FL 32401
Discipline on File
Yes - Click on Discipline/Admin Action tab to see more details
Public Complaint
Yes - Click on Discipline/Admin Action tab to see more details

No secondary locations found.


Name Relationship Profession License Effective Date
DONALDSON, LEEA Additional Surgical Staff Unlicensed Facility Personnel 05/01/2024
GUPTA, ASHISH KUMAR Designated Physician Medical Doctor 113628 08/28/2020
GUPTA, ASHISH KUMAR Owner Medical Doctor 113628 08/28/2020
GUPTA, ASHISH KUMAR Physician Medical Doctor 113628 08/28/2020
GUPTA, WENDY Agent Unlicensed Facility Personnel 08/28/2020
LECLAIR, PENNY Additional Surgical Staff Unlicensed Facility Personnel 05/01/2024
MILLS, TRAVIS EUGENE Recovery Registered Nurse 9176653 08/28/2020
PERSAND, AMANDA Additional Surgical Staff Unlicensed Facility Personnel 08/28/2020
PERSAND, AMANDA Office Manager Unlicensed Facility Personnel 08/28/2020
PERSAUD, CHANDRA Recovery Registered Nurse 9621594 05/07/2024
URQUHART, FAITH KHRISTINA Recovery Registered Nurse 9630913 02/16/2024

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

Name Relationship Profession License Effective Date

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

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 5/12/2024



* 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.