mqa reports license master list for addresses 801...

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MQA Reports License Master List for Addresses 801 : Nursing Home Administrator Page 1 of 41 Expiry Date Sort Order: Rank License Number Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALL Addr = PL File Nbr County Region Rank Lic Nbr Lic Status Expr Dte Date Sec Sta Ad Line 1 Ad Line 2 Ad Line 3 Ad St Ad Zip Ad City Clnt Email Ty Orig Iss Mod Phone Nme Title Nme First Nme Mid Nme Last N Sfx 20 : Active 09/30/2022 1 PLP3, PREC 20 : Clear 1 Nursing Home Ad 10 : Ft. Lauderd ale Broward 1601 NE 26 STREET FL 33305 -1412 FT LAUDER DALE 801 rmarrinso n@marrin son.com PL 7/18/1974 (954) 566-8353 Mr. Ralph A Marrinso n 20 : Active 09/30/2022 476 PLP3, PREC 20 : Clear 1186 Nursing Home Ad 3 : Gainesvi lle Alachua 7207 SW. AVENUE FL 32607 GAINES VILLE 801 kathleenh awk1@g mail.com PL 7/14/1975 352-333- 0800 Ms Kathlee n M Hawk 20 : Active 09/30/2022 646 PLP3, PREC 20 : Clear 1494 Nursing Home Ad 4 : jacksonv ille Duval RIVER GARDEN HEBREW HOME 11401 OLD ST. AUGUS TINE ROAD FL 32258 JACKSO NVILLE 801 mgoetz@r ivergarde n.org PL 9/6/1978 (904) 886-8409 Mr. Martin A Goetz 20 : Active 09/30/2022 706 PLP3, PREC 20 : Clear 1555 Nursing Home Ad NOT PRACTICI NG 801 martincas per25@g mail.com PL 4/24/1979 (850) 488-0595 Mr. Martin E Casper 20 : Active 09/30/2022 732 PLP3, PREC 20 : Clear 1581 Nursing Home Ad 5 : St. Petersbu rg Sarasota 1353 myakka rd FL 34240 SARAS OTA 801 fredlgrady @aol.com PL 6/8/1979 941-322- 6100 Mr Fred Grady 20 : Active 09/30/2022 891 PLP3, PREC 20 : Clear 1744 Nursing Home Ad 10 : Ft. Lauderd ale Broward 1701 N.E. 26TH STREET FL 33305 FORT LAUDER DALE 801 w.savett0 1@hotmai l.com PL 9/19/1980 954-566- 8353 Nha, William D Savett 20 : Active 09/30/2022 989 PLP3, PREC 20 : Clear 1845 Nursing Home Ad 7 : Orlando Orange 1300 HEMPEL AVENUE FL 34761 OCOEE 801 hats0985 @aol.com PL 7/31/1981 813-390- 3391 Ronald Eugene Milliner 20 : Active 09/30/2022 1000 PLP3, PREC 20 : Clear 1856 Nursing Home Ad 7 : Orlando Brevard 1515 PORT MALABAR BLVD. FL 32905 PALM BAY 801 vcacc@a ol.com PL 9/14/1981 321-723- 1235 Mr. Vincent Angelo Cacciato re 20 : Active 09/30/2022 1132 PLP3, PREC 20 : Clear 1990 Nursing Home Ad NOT PRACTICI NG 801 dcross71 @verizon. ent PL 1/4/1983 (850) 488-0595 Mr. David Walling Cross 20 : Active 09/30/2022 1149 PLP3, PREC 20 : Clear 2007 Nursing Home Ad NOT PRACTICI NG 801 debra.wall ace1954 @yahoo.c om PL 12/27/1982 (850) 488-0595 Ms Debra Ann Wallace 20 : Active 09/30/2022 1182 PLP3, PREC 20 : Clear 2040 Nursing Home Ad 4 : jacksonv ille Duval 11411 ARMSDAL E RD FL 32218 JACKSO NVILLE 801 connieben [email protected] PL 6/30/1983 904-714- 3793 Ms Connie M Bend pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR -- FOR INTERNAL USE ONLY -- Florida Department of Health

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Page 1: MQA Reports License Master List for Addresses 801 ...floridasnursinghomeadmin.gov/forms/preceptor_list_AIT.pdfFile Nbr Lic Nbr Rank Lic Region County Status Expr Dte Date Sec Sta Ad

MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 1 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 1 PLP3, PREC

20 : Clear

1 Nursing Home Ad

10 : Ft. Lauderdale

Broward 1601 NE 26 STREET

FL 33305-1412

FT LAUDERDALE

801 [email protected]

PL7/18/1974 (954) 566-8353

Mr. Ralph A Marrinson

20 : Active

09/30/2022 476 PLP3, PREC

20 : Clear

1186 Nursing Home Ad

3 : Gainesville

Alachua 7207 SW. AVENUE

FL 32607GAINESVILLE

801 [email protected]

PL7/14/1975 352-333-0800

Ms Kathleen

M Hawk

20 : Active

09/30/2022 646 PLP3, PREC

20 : Clear

1494 Nursing Home Ad

4 : jacksonville

Duval RIVER GARDEN HEBREW HOME

11401 OLD ST. AUGUSTINE ROAD

FL 32258JACKSONVILLE

801 [email protected]

PL9/6/1978 (904) 886-8409

Mr. Martin A Goetz

20 : Active

09/30/2022 706 PLP3, PREC

20 : Clear

1555 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL4/24/1979 (850) 488-0595

Mr. Martin E Casper

20 : Active

09/30/2022 732 PLP3, PREC

20 : Clear

1581 Nursing Home Ad

5 : St. Petersburg

Sarasota 1353 myakka rd

FL 34240SARASOTA

801 [email protected]

PL6/8/1979 941-322-6100

Mr Fred Grady

20 : Active

09/30/2022 891 PLP3, PREC

20 : Clear

1744 Nursing Home Ad

10 : Ft. Lauderdale

Broward 1701 N.E. 26TH STREET

FL 33305FORT LAUDERDALE

801 [email protected]

PL9/19/1980 954-566-8353

Nha, William D Savett

20 : Active

09/30/2022 989 PLP3, PREC

20 : Clear

1845 Nursing Home Ad

7 : Orlando

Orange 1300 HEMPEL AVENUE

FL 34761OCOEE801 [email protected]

PL7/31/1981 813-390-3391

Ronald Eugene Milliner

20 : Active

09/30/2022 1000 PLP3, PREC

20 : Clear

1856 Nursing Home Ad

7 : Orlando

Brevard 1515 PORT MALABAR BLVD.

FL 32905PALM BAY

801 [email protected]

PL9/14/1981 321-723-1235

Mr. Vincent Angelo Cacciatore

20 : Active

09/30/2022 1132 PLP3, PREC

20 : Clear

1990 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL1/4/1983 (850) 488-0595

Mr. David Walling Cross

20 : Active

09/30/2022 1149 PLP3, PREC

20 : Clear

2007 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL12/27/1982 (850) 488-0595

Ms Debra Ann Wallace

20 : Active

09/30/2022 1182 PLP3, PREC

20 : Clear

2040 Nursing Home Ad

4 : jacksonville

Duval 11411 ARMSDALE RD

FL 32218JACKSONVILLE

801 [email protected]

PL6/30/1983 904-714-3793

Ms Connie M Bend

pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health

Page 2: MQA Reports License Master List for Addresses 801 ...floridasnursinghomeadmin.gov/forms/preceptor_list_AIT.pdfFile Nbr Lic Nbr Rank Lic Region County Status Expr Dte Date Sec Sta Ad

MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 2 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 1188 PLP3, PREC

20 : Clear

2046 Nursing Home Ad

11 : Miami

Miami-Dade

10686 SW 74th Ave

Pinecrest, FL

FL 33156-3830

PINECREST

801 [email protected]

PL6/30/1983 305-283-8532

Mr Terry C Goodman

20 : Active

09/30/2022 1290 PLP3, PREC

20 : Clear

2148 Nursing Home Ad

7 : Orlando

Orange 305 EAST OAK ST.

FL 32703APOPKA

801 [email protected]

PL2/20/1984 407-880-2266

Ms April Marie Doherty

20 : Active

09/30/2022 1303 PLP3, PREC

20 : Clear

2162 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL8/7/1984 (850) 488-0595

Ms. Maureen

Gartland

20 : Active

09/30/2022 1376 PLP3, PREC

20 : Clear

2235 Nursing Home Ad

9 : West Palm Beach

Indian River

1755 37TH STREET

FL 32960VERO BEACH

801 [email protected]

PL3/19/1985 772-567-2443

Ms Nancy S Mcgoldrick

20 : Active

09/30/2022 1390 PLP3, PREC

20 : Clear

2250 Nursing Home Ad

2 : Tallahassee

Gadsden RIVERCHASE H&R CENTER

1017 STRONG ROAD

FL 32351QUINCY801 [email protected]

PL3/19/1985 (850) 875-3711

Ms. Linda J Blackshear

20 : Active

09/30/2022 1391 PLP3, PREC

20 : Clear

2251 Nursing Home Ad

3 : Gainesville

Alachua 6700 N.W. 10TH PL.

FL 32605GAINESVILLE

801 [email protected]

PL3/19/1985 352-331-3111

Mr George C Hamilton

20 : Active

09/30/2022 1444 PLP3, PREC

20 : Clear

2304 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL7/23/1985 (850) 488-0595

Mr. Kenneth Wesley Hawkins

20 : Active

09/30/2022 1506 PLP3, PREC

20 : Clear

2366 Nursing Home Ad

7 : Orlando

Orange 401 WINGHURST BLVD.

FL 32828ORLANDO

801 [email protected]

PL11/26/1985 (407) 342-9528

James Lee Mott

20 : Active

09/30/2022 1599 PLP3, PREC

20 : Clear

2461 Nursing Home Ad

10 : Ft. Lauderdale

Broward 7751 W. BROWARD BLVD.

FL 33324PLANTATION

801 [email protected]

PL8/11/1986 954-473-8040

Mr Steven Beryl Ostreich

20 : Active

09/30/2022 1660 PLP3, PREC

20 : Clear

2522 Nursing Home Ad

11 : Miami

Miami-Dade

899 NW 4TH ST

FL 33128-1309

MIAMI801 [email protected]

PL11/25/1986Mr. Richard Eugene Stacey

20 : Active

09/30/2022 1673 PLP3, PREC

20 : Clear

2536 Nursing Home Ad

5 : St. Petersburg

Pinellas 4250 66 ST. N.

FL 33709SAINT PETERSBURG

801 [email protected]

PL3/20/1987 727-546-2405

Jonathan

W Bradford

pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health

Page 3: MQA Reports License Master List for Addresses 801 ...floridasnursinghomeadmin.gov/forms/preceptor_list_AIT.pdfFile Nbr Lic Nbr Rank Lic Region County Status Expr Dte Date Sec Sta Ad

MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 3 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 1719 PLP3, PREC

20 : Clear

2582 Nursing Home Ad

4 : jacksonville

Duval CATHEDRAL GERONTOLOGY CENTER

333 E. ASHLEY STREET

FL 32202JACKSONVILLE

801 [email protected]

PL7/31/1987 (904) 798-5312

Nha Sharon Gail Brown

20 : Active

09/30/2022 1795 PLP3, PREC

20 : Clear

2658 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/20/1987 (850) 488-0595

Mrs. Barbara A Landy

20 : Active

09/30/2022 1839 PLP3, PREC

20 : Clear

2702 Nursing Home Ad

4 : jacksonville

Volusia 1851 ELKCAM BOULEVARD

FL 32725DELTONA

801 [email protected]

PL4/18/1988 386-789-3769

Nha Denise Diane Crosby

20 : Active

09/30/2022 1855 PLP3, PREC

20 : Clear

2718 Nursing Home Ad

5 : St. Petersburg

Pinellas 1270 TURNER STREET

FL 33756CLEARWATER

801 [email protected]

PL4/18/1988 727-443-7639

David P Jones

20 : Active

09/30/2022 1868 PLP3, PREC

20 : Clear

2731 Nursing Home Ad

9 : West Palm Beach

Palm Beach

4801 NE 5TH AVE.

FL 33431BOCA RATON

801 [email protected]

PL4/18/1988 (561) 251-8179

Ms Kathleen

M Morrissey

20 : Active

09/30/2022 1881 PLP3, PREC

20 : Clear

2744 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL10/14/1988 (850) 488-0595

Mr. Christopher

J Adams

20 : Active

09/30/2022 1895 PLP3, PREC

20 : Clear

2758 Nursing Home Ad

NOT PRACTICING

801 PL10/14/1988 (850) 488-0595

Richard J Brady

20 : Active

09/30/2022 1913 PLP3, PREC

20 : Clear

2776 Nursing Home Ad

7 : Orlando

Seminole 1055 WEST TOWN PARKWAY

FL 32714ALTAMONTE SPRINGS

801 [email protected]

PL10/14/1988 407-865-8000

Mr Rafael E Fonseca

20 : Active

09/30/2022 1937 PLP3, PREC

20 : Clear

2801 Nursing Home Ad

9 : West Palm Beach

Palm Beach

2180 HYPOLUXO RD.

FL 33462LANTANA

801 [email protected]

PL10/17/1988 561-582-3000

Mr Lionel N Jadoo

20 : Active

09/30/2022 1991 PLP3, PREC

20 : Clear

2856 Nursing Home Ad

3 : Gainesville

Marion 2700 SW 34TH STREET

FL 34474OCALA801 [email protected]

PL10/17/1988 (352) 854-6262

Mrs. Jennifer L Mikula

20 : Active

09/30/2022 2014 PLP3, PREC

20 : Clear

2879 Nursing Home Ad

10 : Ft. Lauderdale

Broward 1601 NE 26TH STREET

FL 33305FORT LAUDERDALE

801 [email protected]

PL1/24/1989 (954) 566-8353

Scott D Lipman

pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health

Page 4: MQA Reports License Master List for Addresses 801 ...floridasnursinghomeadmin.gov/forms/preceptor_list_AIT.pdfFile Nbr Lic Nbr Rank Lic Region County Status Expr Dte Date Sec Sta Ad

MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 4 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 2024 PLP3, PREC

20 : Clear

2889 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL4/13/1989 (850) 488-0595

Mrs Charlotte

Patrice Butts-Leonard

20 : Active

09/30/2022 2039 PLP3, PREC

20 : Clear

2905 Nursing Home Ad

4 : jacksonville

Duval 10338 MARSH HAWK DRIVE

FL 32218JACKSONVILLE

801 [email protected]

PL4/13/1989Dr Dewayne

K Harvey

20 : Active

09/30/2022 2043 PLP3, PREC

20 : Clear

2909 Nursing Home Ad

10 : Ft. Lauderdale

Broward BROWARD NURSING & REHABILITATI

1330 S. ANDREWS AVENUE

FL 33316FT. LAUDERDALE

801 [email protected]

PL4/13/1989 954-524-5587

Mr. John William Hymans

20 : Active

09/30/2022 2091 PLP3, PREC

20 : Clear

2958 Nursing Home Ad

3 : Gainesville

Gilchrist 606 NE 7TH STREET

FL 32693TRENTON

801 [email protected]

PL10/17/1989 (352) 463-7101

Ms. Joanna Colonel Buckles

20 : Active

09/30/2022 2092 PLP3, PREC

20 : Clear

2959 Nursing Home Ad

11 : Miami

Miami-Dade

13900 NE 3 COURT

FL 33161NORTH MIAMI

801 [email protected]

PL10/17/1989 305-893-2288

Mr Eddie Y Bursztyn

20 : Active

09/30/2022 2106 PLP3, PREC

20 : Clear

2973 Nursing Home Ad

7 : Orlando

Orange 550 WEST MORSE BLVD.

FL 32789WINTER PARK

801 [email protected]

PL10/18/1989 407-644-6634

Ms Elizabeth

Kilfeder Barton

20 : Active

09/30/2022 2107 PLP3, PREC

20 : Clear

2974 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL10/18/1989 (850) 488-0595

Craig Koff

20 : Active

09/30/2022 2109 PLP3, PREC

20 : Clear

2976 Nursing Home Ad

2 : Tallahassee

Calhoun 16690 SW. CHIPOLA ROAD

FL 32424BLOUNTSTOWN

801 [email protected]

PL10/18/1989 850-674-4311

Exec Thomas Lee Mcdaniel

20 : Active

09/30/2022 2115 PLP3, PREC

20 : Clear

2983 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL10/18/1989 (850) 488-0595

Mr Robert Curtis Murphy Jr

20 : Active

09/30/2022 2128 PLP3, PREC

20 : Clear

2997 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL1/26/1990 (850) 488-0595

Michael D Ward

pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health

Page 5: MQA Reports License Master List for Addresses 801 ...floridasnursinghomeadmin.gov/forms/preceptor_list_AIT.pdfFile Nbr Lic Nbr Rank Lic Region County Status Expr Dte Date Sec Sta Ad

MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 5 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 2148 PLP3, PREC

20 : Clear

3018 Nursing Home Ad

3 : Gainesville

Lake 900 CR 466

FL 32159LADY LAKE

801 [email protected]

PL4/2/1990 (352) 430-0017

Mrs Deborah

Lorraine Brazill

20 : Active

09/30/2022 2151 PLP3, PREC

20 : Clear

3021 Nursing Home Ad

NOT PRACTICING

801 PL4/2/1990 (850) 488-0595

Kathryn Kondolf-Harmer

20 : Active

09/30/2022 2164 PLP3, PREC

20 : Clear

3034 Nursing Home Ad

3 : Gainesville

Alachua 4000 SW. 20TH AVENUE

FLORIDA

FL 32607GAINESVILLE

801 [email protected]

PL4/2/1990 352-372-1981

Richard Louis Soehner

20 : Active

09/30/2022 2178 PLP3, PREC

20 : Clear

3048 Nursing Home Ad

5 : St. Petersburg

Pinellas 10300 4TH STREET NORTH

FL 33716SAINT PETERSBURG

801 [email protected]

PL10/3/1990 727-568-1054

Kathleen

A Walsh

20 : Active

09/30/2022 2192 PLP3, PREC

20 : Clear

3062 Nursing Home Ad

4 : jacksonville

Volusia 400 E. HOWRY AVE

FL 32724DELAND801 [email protected]

PL10/3/1990 386-822-6900

Mrs. Cheryl Ann Fredsall

20 : Active

09/30/2022 2209 PLP3, PREC

20 : Clear

3079 Nursing Home Ad

4 : jacksonville

Volusia 501 PALM AVE

FL 32117PALALKA

801 [email protected]

PL10/3/1990 386-328-1472

Mr R Bruce Mccorkle

20 : Active

09/30/2022 2215 PLP3, PREC

20 : Clear

3085 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL10/3/1990 (850) 488-0595

Mrs Jennifer Palleschi

20 : Active

09/30/2022 2229 PLP3, PREC

20 : Clear

3099 Nursing Home Ad

3 : Gainesville

Dixie 583 NE 351 HWY

FL 32628CROSS CITY

801 [email protected]

PL2/22/1991 352-498-2005

Mrs. Terrye W Dubberly

20 : Active

09/30/2022 2238 PLP3, PREC

20 : Clear

3108 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL2/22/1991 (850) 488-0595

William John Mess

20 : Active

09/30/2022 2245 PLP3, PREC

20 : Clear

3115 Nursing Home Ad

7 : Orlando

Orange 2075 LOCH LOMEAD DRIVE

FL 32792WINTER PARK

801 [email protected]

PL2/22/1991 407-628-5418

Mr. Stephen Rykiel-Foster

20 : Active

09/30/2022 2249 PLP3, PREC

20 : Clear

3119 Nursing Home Ad

7 : Orlando

Orange 2500 WEST CHURCH STREET

FL 32805ORLANDO

801 [email protected]

PL5/20/1991 (407) 376-9034

Mrs Eloise Ann Abrahams

pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health

Page 6: MQA Reports License Master List for Addresses 801 ...floridasnursinghomeadmin.gov/forms/preceptor_list_AIT.pdfFile Nbr Lic Nbr Rank Lic Region County Status Expr Dte Date Sec Sta Ad

MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 6 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 2283 PLP3, PREC

20 : Clear

3154 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL8/16/1991 (850) 488-0595

Mrs. Dawne P Dries

20 : Active

09/30/2022 2306 PLP3, PREC

20 : Clear

3177 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL8/16/1991 (850) 488-0595

Mr Edwin Rojas

20 : Active

09/30/2022 2320 PLP3, PREC

20 : Clear

3191 Nursing Home Ad

6 : Tampa

Hillsborough

8603 SWANN RIDGE CT

FL 33647TAMPA801 [email protected]

PL11/15/1991 (727) 492-4266

Mr. Kirk Alan Copley

20 : Active

09/30/2022 2348 PLP3, PREC

20 : Clear

3219 Nursing Home Ad

2 : Tallahassee

Leon 1300 Miccosukee Road

FL 32308TALLAHASSEE

801 [email protected]

PL2/18/1992 850-431-5371

Mrs Judith T Greenwald

20 : Active

09/30/2022 2384 PLP3, PREC

20 : Clear

3255 Nursing Home Ad

3 : Gainesville

Sumter 3875 WEDGEWOOD LANE

FL 32162THE VILLAGES

801 [email protected]

PL5/14/1992 352-674-4848

Todd P Martin

20 : Active

09/30/2022 2389 PLP3, PREC

20 : Clear

3260 Nursing Home Ad

1 : Pensacola

Escambia 10095 HILLVIEW AVE.

FL 32514PENSACOLA

801 [email protected]

PL5/14/1992 850-479-4000

Lois G Petty

20 : Active

09/30/2022 2408 PLP3, PREC

20 : Clear

3279 Nursing Home Ad

4 : jacksonville

Volusia 550 NATIONAL HEALTHCARE DR

FL 32114DAYTONA BEACH

801 [email protected]

PL8/18/1992 386-257-6362

Ross Baird

20 : Active

09/30/2022 2409 PLP3, PREC

20 : Clear

3280 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL8/18/1992 (850) 488-0595

Mrs. Brenda J Basford

20 : Active

09/30/2022 2448 PLP3, PREC

20 : Clear

3319 Nursing Home Ad

10 : Ft. Lauderdale

Broward 387 FRANKLIN ST

FL 33019HOLLYWOOD

801 [email protected]

PL8/18/1992 786-517-6999

Mr Kim Grady Simmons

20 : Active

09/30/2022 2455 PLP3, PREC

20 : Clear

3326 Nursing Home Ad

5 : St. Petersburg

Sarasota 109 DA VINCI DR

FL 34275NOKOMIS

801 [email protected]

PL8/18/1992Ms. Connie S Tolley

20 : Active

09/30/2022 2456 PLP3, PREC

20 : Clear

3327 Nursing Home Ad

6 : Tampa

Hillsborough

3501 BAYSHORE BLVD.

FL 33629TAMPA801 [email protected]

PL8/18/1992 813-837-1083

Caridad Vinas

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 7 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 2479 PLP3, PREC

20 : Clear

3350 Nursing Home Ad

11 : Miami

Miami-Dade

832 Hampton Court

FL 33326WESTON

801 [email protected]

PL12/15/1992 305-548-4020

Teresita Garcia

20 : Active

09/30/2022 2503 PLP3, PREC

20 : Clear

3374 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL2/17/1993 (850) 488-0595

Joseph M Cagno

20 : Active

09/30/2022 2507 PLP3, PREC

20 : Clear

3378 Nursing Home Ad

7 : Orlando

Orange 3355 E. Semoran Blvd

FL 32703APOPKA

801 [email protected]

PL2/17/1993 407-862-6263

Mr. Michael David Fogg

20 : Active

09/30/2022 2515 PLP3, PREC

20 : Clear

3386 Nursing Home Ad

5 : St. Petersburg

Pinellas 9393 PARK BLVD.

FL 33715SEMINOLE

801 [email protected]

PL2/22/1993 727-391-2200

Anita Concetta

Faulmann

20 : Active

09/30/2022 2520 PLP3, PREC

20 : Clear

3391 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL3/2/1993 (850) 488-0595

Gary Scott Cooke

20 : Active

09/30/2022 2522 PLP3, PREC

20 : Clear

3393 Nursing Home Ad

5 : St. Petersburg

Manatee 8104 Tuttle Avenue

FL 34243SARASOTA

801 [email protected]

PL3/15/1993 941 360 6411

Laura Joy Haraburda

20 : Active

09/30/2022 2527 PLP3, PREC

20 : Clear

3398 Nursing Home Ad

11 : Miami

Miami-Dade

3671 SOUTH MIAMI

FL 33133MIAMI801 [email protected]

PL5/10/1993Heidi Tucker

20 : Active

09/30/2022 2535 PLP3, PREC

20 : Clear

3406 Nursing Home Ad

9 : West Palm Beach

Palm Beach

2939 South Haverhill Road

FL 33415WEST PALM BEACH

801 [email protected]

PL5/18/1993 (561) 641-3130

Mrs Adela Baldo

20 : Active

09/30/2022 2550 PLP3, PREC

20 : Clear

3421 Nursing Home Ad

8 : Ft. Myers

Highlands LAKE PLACID HEALTH AND REHAB

125 TOMOKA HEIGHTS BOULEVARD

FL 33852LAKE PLACID

801 [email protected]

PL8/3/1993 (813) 465-7200

Admi David Jeffrey Smith

20 : Active

09/30/2022 2553 PLP3, PREC

20 : Clear

3424 Nursing Home Ad

11 : Miami

Miami-Dade

11501 NE 7TH AVENUE

FL 33161BISCAYNE PARK

801 [email protected]

PL8/3/1993 (305) 525-9552

Mrs Emma Fabros Dial

20 : Active

09/30/2022 2587 PLP3, PREC

20 : Clear

3458 Nursing Home Ad

6 : Tampa

Pasco 7350 DAIRY ROAD

FL 33540ZEPHYRHILLS

801 [email protected]

PL2/9/1994 813-799-4300

Mrs. Kim Alison Ridinger

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 8 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 2597 PLP3, PREC

20 : Clear

3468 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL2/9/1994 (850) 488-0595

Thomas Arthur O'Neill

20 : Active

09/30/2022 2598 PLP3, PREC

20 : Clear

3469 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL2/9/1994 (850) 488-0595

Mr. Barry Preter

20 : Active

09/30/2022 2599 PLP3, PREC

20 : Clear

3470 Nursing Home Ad

5 : St. Petersburg

Pinellas 45 KATHERINE BLVD

FL 34684PALM HARBOR

801 [email protected]

PL2/9/1994 (727) 7871500

Ms Merrilee Lang

20 : Active

09/30/2022 2605 PLP3, PREC

20 : Clear

3476 Nursing Home Ad

5 : St. Petersburg

Pinellas 255 59TH ST N.

FL 33710SAINT PETERSBURG

801 [email protected]

PL2/9/1994 727-345-2775

Mr Suresh Vasanth Pai

20 : Active

09/30/2022 2609 PLP3, PREC

20 : Clear

3480 Nursing Home Ad

11 : Miami

Miami-Dade

220 SIERRA DRIVE

FL 33179MIAMI801 [email protected]

PL2/9/1994 305-653-8427

Ms Maria Del Pilar

Iglesias

20 : Active

09/30/2022 2610 PLP3, PREC

20 : Clear

3481 Nursing Home Ad

5 : St. Petersburg

Sarasota 950 PINEBROOK RD.

FL 34285VENICE801 [email protected]

PL2/9/1994 941-484-8801

Ms. Susan Elizabeth

Shoffstall

20 : Active

09/30/2022 2630 PLP3, PREC

20 : Clear

3501 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL5/24/1994 (850) 488-0595

Mrs. Ilene Berkon

20 : Active

09/30/2022 2636 PLP2, PLP3, PREC

20 : Clear

3507 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL5/31/1994 (850) 488-0595

Mr. Louis Philip Maltaghati

20 : Active

09/30/2022 2652 PLP3, PREC

20 : Clear

3523 Nursing Home Ad

6 : Tampa

Hillsborough

13806 N 46th Fairway Oaks Center

1380 Florida FL 33613TAMPA801 [email protected]

PL8/18/1994 813-977-4214

Dawn Jones Debrunner

20 : Active

09/30/2022 2668 PLP3, PREC

20 : Clear

3539 Nursing Home Ad

11 : Miami

Miami-Dade

19225 SW. 87 AVENUE

FL 33157CUTLER BAY

801 [email protected]

PL8/18/1994 305-256-3545

Ms Desiree Sebastian

20 : Active

09/30/2022 2676 PLP3, PREC

20 : Clear

3547 Nursing Home Ad

11 : Miami

Miami-Dade

19333 W COUNTRY CLUB DR

VI AT AVENTURA

FL 33180AVENTURA

801 [email protected]

PL9/13/1994 305-682-4800

Mrs. Pamela Green Allison

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 9 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 2679 PLP3, PREC

20 : Clear

3550 Nursing Home Ad

9 : West Palm Beach

Palm Beach

5430 LINTON BLVD

FL 33484DELRAY BEACH

801 [email protected]

PL9/15/1994 (561) 495-3188

Mrs Gilda Renee Anderson

20 : Active

09/30/2022 2685 PLP3, PREC

20 : Clear

3556 Nursing Home Ad

6 : Tampa

Hillsborough

Fletcher Health & Rehab

518 W Fletcher Avenue

FL 33612TAMPA801 [email protected]

PL11/16/1994 813-265-1600

Mr Scott James Allen

20 : Active

09/30/2022 2699 PLP3, PREC

20 : Clear

3570 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/16/1994 (850) 488-0595

Kimberly

Ann Lehigh

20 : Active

09/30/2022 2703 PLP3, PREC

20 : Clear

3574 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/16/1994 (850) 488-0595

Mr. Robert Daniel Mead

20 : Active

09/30/2022 2707 PLP3, PREC

20 : Clear

3578 Nursing Home Ad

9 : West Palm Beach

Palm Beach

RPB HEALTH AND REHAB CENTER

600 BUSINESS PARKWAY

FL 33411ROYAL PALM BCH

801 [email protected]

PL12/1/1994 (561) 798-3700

Nha Dieudegrace

Vincius Achille

20 : Active

09/30/2022 2726 PLP3, PREC

20 : Clear

3597 Nursing Home Ad

1 : Pensacola

Escambia 1336 ST. ANDREWS BLVD.

FL 32504PENSACOLA

801 [email protected]

PL2/2/1995 850-763-3911

Mr Patrick Robert Davies

20 : Active

09/30/2022 2767 PLP3, PREC

20 : Clear

3638 Nursing Home Ad

5 : St. Petersburg

Pinellas 530 WALDEN COURT

FL 34698DUNEDIN

801 [email protected]

PL8/8/1995 (727) 432-4270

Ms. Stella Pappas

20 : Active

09/30/2022 2772 PLP3, PREC

20 : Clear

3643 Nursing Home Ad

4 : jacksonville

Volusia 2810 Enterprise RD

FL 32713DEBARY801 [email protected]

PL8/8/1995 386-668-8818

Mrs. Catherine

Marie Holland

20 : Active

09/30/2022 2790 PLP3, PREC

20 : Clear

3661 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/14/1995 (850) 488-0595

Mr. Robert S. Goldstein

20 : Active

09/30/2022 2793 PLP3, PREC

20 : Clear

3664 Nursing Home Ad

6 : Tampa

Pasco 2144 Welbilt Blvd

FL 34655TRINITY801 [email protected]

PL11/14/1995 727-859-4100

Kendra Lynn Mulloy

20 : Active

09/30/2022 2797 PLP3, PREC

20 : Clear

3668 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/14/1995 (850) 488-0595

Marla Faye Cleghorn

pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 10 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 2799 PLP3, PREC

20 : Clear

3670 Nursing Home Ad

11 : Miami

Miami-Dade

8333 W. OKEECHOBEE RD.

FL 33016HIALEAH GARDENS

801 [email protected]

PL11/14/1995 305-556-9900

Mr. Frank Anthony Farinella Jr

20 : Active

09/30/2022 2803 PLP3, PREC

20 : Clear

3674 Nursing Home Ad

7 : Orlando

Orange 3211 ROUSE ROAD

FL 32817ORLANDO

801 [email protected]

PL11/14/1995 407-281-1070

Mr. Joseph Mark Jicha

20 : Active

09/30/2022 2805 PLP3, PREC

20 : Clear

3676 Nursing Home Ad

6 : Tampa

Hernando 11603 Fairfield Court

FL 34609SPRING HILL

801 [email protected]

PL11/14/1995 352-848-3800

Terry Lee Delia

20 : Active

09/30/2022 2814 PLP3, PREC

20 : Clear

3685 Nursing Home Ad

5 : St. Petersburg

Pinellas 10501 ROOSEVELT BLVD

FL 33716SAINT PETERSBURG

801 [email protected]

PL11/14/1995 727-577-3800

Mr. Joseph Christopher

Riggs

20 : Active

09/30/2022 2846 PLP3, PREC

20 : Clear

3717 Nursing Home Ad

11 : Miami

Miami-Dade

1561 SW 151 ROAD

FL 33194-2742

MIAMI801 [email protected]

PL2/13/1996Lazaro Antonio Lazo

20 : Active

09/30/2022 2847 PLP3, PREC

20 : Clear

3718 Nursing Home Ad

10 : Ft. Lauderdale

Broward The Forum at Deer Creek

3001 Deer Creek Country Club Blvd.

FL 33442DEERFIELD BEACH

801 [email protected]

PL2/13/1996 954-363-3488

Mrs Kathleen

H Marciante

20 : Active

09/30/2022 2849 PLP3, PREC

20 : Clear

3720 Nursing Home Ad

2 : Tallahassee

Leon 4449 MEANDERING WAY

WESTMINSTER OAKS HEALTH CENTER

FL 32308TALLAHASSEE

801 [email protected]

PL2/13/1996 850-878-1136

Mrs. Shannon

Ewing Sauls

20 : Active

09/30/2022 2858 PLP3, PREC

20 : Clear

3729 Nursing Home Ad

5 : St. Petersburg

Sarasota 1959 N HONORE AVENUE

FL 34235SARASOTA

801 [email protected]

PL5/20/1996 941-379-3553

Teresa Marie Martin

20 : Active

09/30/2022 2865 PLP3, PREC

20 : Clear

3736 Nursing Home Ad

5 : St. Petersburg

Pinellas 8701 49TH ST N.

FL 33782PINELLAS PARK

801 [email protected]

PL5/20/1996 727-546-4661

Timothy James Selleck

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 11 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 2882 PLP3, PREC

20 : Clear

3756 Nursing Home Ad

5 : St. Petersburg

Manatee 2010 MANATEE AVE. EAST

FL 34208BRADENTON

801 [email protected]

PL8/15/1996 941-747-3706

Mr. Gerard P Dahill

20 : Active

09/30/2022 2922 PLP3, PREC

20 : Clear

3796 Nursing Home Ad

10 : Ft. Lauderdale

Broward 200 SE 19TH AVE

FL 33060POMPANO BEACH

801 [email protected]

PL11/13/1996 (954)943-7638

Richard Markhoff

20 : Active

09/30/2022 2927 PLP3, PREC

20 : Clear

3801 Nursing Home Ad

5 : St. Petersburg

Pinellas 2851 TAMPA RD

FL 34684PALM HARBOR

801 [email protected]

PL11/13/1996 727-787-4777

Su Chae Reynard

20 : Active

09/30/2022 2934 PLP3, PREC

20 : Clear

3808 Nursing Home Ad

8 : Ft. Myers

Charlotte 1348 SEA HORSE CT

FL 33950PUNTA GORDA

801 [email protected]

PL11/13/1996 941-255-5855

Mr Frank Stanford

Weyer Jr

20 : Active

09/30/2022 2951 PLP3, PREC

20 : Clear

3825 Nursing Home Ad

7 : Orlando

Orange 648 West Bay Street

FL 34787WINTER GARDEN

801 [email protected]

PL2/13/1997 904-615-3113

Ms. Diane Delorys King

20 : Active

09/30/2022 2968 PLP3, PREC

20 : Clear

3842 Nursing Home Ad

10 : Ft. Lauderdale

Broward 700 SW 4th Street

FL 33060POMPANO BEACH

801 [email protected]

PL3/10/1997 (954) 247-5802

Nha Mark D Rayner

20 : Active

09/30/2022 2969 PLP3, PREC

20 : Clear

3843 Nursing Home Ad

7 : Orlando

Brevard 1 NORTH 1ST STREET

UNIT 15 FL 32931COCOA BEACH

801 [email protected]

PL5/21/1997 352-669-2133

Michael Jett Adams

20 : Active

09/30/2022 2974 PLP3, PREC

20 : Clear

3848 Nursing Home Ad

3 : Gainesville

NOT PRACTICING

801 [email protected]

PL5/21/1997Mr James Eric Bell

20 : Active

09/30/2022 2977 PLP3, PREC

20 : Clear

3851 Nursing Home Ad

8 : Ft. Myers

Lee 4100 Center Point Drive

Suite 112

FL 33916FT MYERS

801 [email protected]

PL5/21/1997 239-418-2550

Mr Weston R Edwards

20 : Active

09/30/2022 2985 PLP3, PREC

20 : Clear

3859 Nursing Home Ad

11 : Miami

Miami-Dade

7735 NW 146 ST, SUITE 204

FL 33141MIAMI LAKES

801 [email protected]

PL5/21/1997 (305) 409-8277

Mrs Michelle Dieudonne

Merilus

20 : Active

09/30/2022 3012 PLP3, PREC

20 : Clear

3886 Nursing Home Ad

6 : Tampa

Pasco 9824 JASMINE BROOK CIRCLE

FL 34638LAND O LAKES

801 [email protected]

PL8/12/1997 (352) 799-1451

Mr. Reginald

L Eldridge

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 12 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 3014 PLP3, PREC

20 : Clear

3888 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL8/12/1997 (850) 488-0595

Ronald M Hollerand

20 : Active

09/30/2022 3026 PLP3, PREC

20 : Clear

3900 Nursing Home Ad

8 : Ft. Myers

Lee 15071 Shell Point Blvd.

FL 33908FORT MYERS

801 [email protected]

PL8/12/1997 239-466-1111

Nh Douglas James Potts

20 : Active

09/30/2022 3039 PLP3, PREC

20 : Clear

3913 Nursing Home Ad

2 : Tallahassee

Bay 1401 KESTREL STREET

FL 32405PANAMA CITY

801 [email protected]

PL11/24/1997 (850) 597-0579

Mr Fate Preston Brown

20 : Active

09/30/2022 3040 PLP3, PREC

20 : Clear

3914 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/24/1997 (850) 488-0595

Anthony Oreste Brunicardi

20 : Active

09/30/2022 3043 PLP3, PREC

20 : Clear

3917 Nursing Home Ad

0 : None Out Of State

2230 Liliha Street

HI 96817HONOLULU

801 [email protected]

PL11/24/1997 808-547-6000

Dr. Hershel Caywood

Jr.

20 : Active

09/30/2022 3048 PLP3, PREC

20 : Clear

3922 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/24/1997 (850) 488-0595

Mr. James W. Gilley, Jr.

20 : Active

09/30/2022 3053 PLP3, PREC

20 : Clear

3927 Nursing Home Ad

10 : Ft. Lauderdale

Broward 4200 WASHINGTON ST.

FL 33021HOLLYWOOD

801 [email protected]

PL11/24/1997 954-961-6300

Sonja Amelia Jorgensen

20 : Active

09/30/2022 3063 PLP3, PREC

20 : Clear

3937 Nursing Home Ad

6 : Tampa

Polk 3110 OAKBRIDGE BLVD E.

FL 33802LAKELAND

801 [email protected]

PL11/24/1997 863-619-2102

Devon Anthony Palmer

20 : Active

09/30/2022 3067 PLP3, PREC

20 : Clear

3941 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/24/1997 (850) 488-0595

Mr. Sidney L Schiff

20 : Active

09/30/2022 3074 PLP3, PREC

20 : Clear

3948 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL1/6/1998 (850) 488-0595

Jonathan

David Hunt

20 : Active

09/30/2022 3085 PLP3, PREC

20 : Clear

3959 Nursing Home Ad

9 : West Palm Beach

Palm Beach

6152 North Verde Trail

FL 33433BOCA RATON

801 [email protected]

PL2/20/1998 (561) 210-0188

Joya Marotta

20 : Active

09/30/2022 3087 PLP3, PREC

20 : Clear

3961 Nursing Home Ad

10 : Ft. Lauderdale

Broward 9711 W. OAKLAND PARK BLVD.

FL 33351SUNRISE

801 [email protected]

PL2/20/1998 954-572-4000

Mr. Jeff Aaron Nusbaum

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 13 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 3109 PLP3, PREC

20 : Clear

3983 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL5/21/1998 (850) 488-0595

Nha Joyce Kadziolka

20 : Active

09/30/2022 3119 PLP3, PREC

20 : Clear

3993 Nursing Home Ad

11 : Miami

Miami-Dade

5200 NE 2nd Avenue

FL 33137MIAMI801 [email protected]

PL5/21/1998 305-514-8745

Jason Scott Pincus

20 : Active

09/30/2022 3124 PLP3, PREC

20 : Clear

3998 Nursing Home Ad

6 : Tampa

Hernando 7045 EVERGREEN WOODS TRAIL

FL 34608SPRING HILL

801 [email protected]

PL5/21/1998 352-596-8371

Mr Ronald Louis Swonger

20 : Active

09/30/2022 3131 PLP3, PREC

20 : Clear

4005 Nursing Home Ad

7 : Orlando

Brevard 2125 WEST NEW HAVEN AVE.

FL 32904WEST MELBOURNE

801 [email protected]

PL6/8/1998 321-725-7360

Kenneth Kelsey Ragin

20 : Active

09/30/2022 3153 PLP3, PREC

20 : Clear

4027 Nursing Home Ad

4 : jacksonville

Clay 1701 PARK AVENUE

FL 32073ORANGE PARK

801 [email protected]

PL8/11/1998 904-824-1755

Mr William G Tippins

20 : Active

09/30/2022 3161 PLP3, PREC

20 : Clear

4035 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL12/1/1998 (850) 488-0595

Mr Bernardo

J Carotenuto

20 : Active

09/30/2022 3182 PLP3, PREC

20 : Clear

4056 Nursing Home Ad

6 : Tampa

Hillsborough

407 Manns Harbor dRIVE

FL 33572APOLLO BEACH

801 [email protected]

PL12/22/1998 813-310-7997

Ms Jacqueline

Frances Hurt

20 : Active

09/30/2022 3183 CEAD, PLP3, PREC

20 : Clear

4057 Nursing Home Ad

5 : St. Petersburg

Pinellas 904 ALLEN DR.

FL 33764CLEARWATER

801 [email protected]

PL12/24/1998Robert Alan Evans

20 : Active

09/30/2022 3187 PLP3, PREC

20 : Clear

4061 Nursing Home Ad

5 : St. Petersburg

Sarasota 5381 DESOTO ROAD

FL 34235SARASOTA

801 [email protected]

PL1/21/1999 941-335-6111

Nha Vernon James Zeger

20 : Active

09/30/2022 3192 PLP3, PREC

20 : Clear

4066 Nursing Home Ad

7 : Orlando

Brevard 8050 SAWGLASS HILL ROAD

FL 32940MELBOURNE

801 [email protected]

PL3/2/1999 321-752-1000

Matthew

Ray File

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801 : Nursing Home AdministratorPage 14 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 3199 PLP3, PREC

20 : Clear

4073 Nursing Home Ad

5 : St. Petersburg

Sarasota Beneva Lakes Healthcare

741 South Beneva Road

FL 34232SARASOTA

801 [email protected]

PL3/2/1999 (941)957-0310

J Patrick Ladehoff

20 : Active

09/30/2022 3207 PLP3, PREC

20 : Clear

4081 Nursing Home Ad

1 : Pensacola

Escambia 9310 FOWLER AVENUE

FL 32534PENSACOLA

801 [email protected]

PL3/2/1999 850-430-0600

Mrs Mary Silewski Reid

20 : Active

09/30/2022 3211 PLP3, PREC

20 : Clear

4085 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL3/3/1999 (850) 488-0595

Mrs. Tracy Quinn Hooks

20 : Active

09/30/2022 3216 PLP3, PREC

20 : Clear

4090 Nursing Home Ad

10 : Ft. Lauderdale

Broward 2121 E. Commercial Boulevard

FL 33308FT LAUDERDALE

801 [email protected]

PL4/19/1999 954-771-8400

Ms Marcia S Couitt

20 : Active

09/30/2022 3220 PLP3, PREC

20 : Clear

4094 Nursing Home Ad

6 : Tampa

Hillsborough

8720 JACKSON SPRINGS RD

FL 33615TAMPA801 [email protected]

PL6/1/1999 813-549-6700

Ms Jackie Renae Aftanas

20 : Active

09/30/2022 3224 PLP3, PREC

20 : Clear

4098 Nursing Home Ad

7 : Orlando

Brevard 961 STRATFORD PLACE

FL 32940MELBOURNE

801 [email protected]

PL6/1/1999 407-383-5642

Jeffrey Edward Cleveland

20 : Active

09/30/2022 3225 PLP3, PREC

20 : Clear

4099 Nursing Home Ad

4 : jacksonville

Clay 294 RIDGELINE COURT

FL 32065ORANGE PARK

801 [email protected]

PL6/1/1999 904-703-1968

Mrs Rebecca

Marie Matheny

20 : Active

09/30/2022 3243 PLP3, PREC

20 : Clear

4117 Nursing Home Ad

11 : Miami

Miami-Dade

WEST GABLES HEALTH CARE CENTER

2525 SW 75TH AVENUE

FL 33155MIAMI801 [email protected]

PL8/16/1999 (305) 265-9391

Mr Marco Antonio Carrasco

20 : Active

09/30/2022 3258 PLP3, PREC

20 : Clear

4132 Nursing Home Ad

1 : Pensacola

Escambia HAVEN OF OUR LADY OF PEACE

1900 SUMMIT BLVD.

FL 32503PENSACOLA

801 [email protected]

PL8/16/1999 (850) 436-5900

Martha Isabel Perez

20 : Active

09/30/2022 3260 PLP3, PREC

20 : Clear

4134 Nursing Home Ad

1 : Pensacola

Okaloosa 114 THIRD ST. SE.

FL 32548FORT WALTON BEACH

801 [email protected]

PL8/16/1999 850-243-6134

Tunecia Lashun Sheffield

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 15 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 3419 PLP3, PREC

20 : Clear

4149 Nursing Home Ad

9 : West Palm Beach

Palm Beach

Health Center Sinai Residences

21044 95th AVE S

FL 33428BOCA RATON

801 [email protected]

PL11/23/1999 561-609-4041

Jay Daniel Mikosch

20 : Active

09/30/2022 3392 PLP3, PREC

20 : Clear

4155 Nursing Home Ad

5 : St. Petersburg

Pinellas 7948 41ST ST.

FL 33781PINELLAS PARK

801 [email protected]

PL11/23/1999 727-278-0525

Cindy L Daughters

20 : Active

09/30/2022 3397 PLP3, PREC

20 : Clear

4157 Nursing Home Ad

2 : Tallahassee

Leon 4449 MEANDERING WAY

FL 32308TALLAHASSEE

801 [email protected]

PL11/23/1999 850-878-1136

Mrs. Melissa Ann Fijalkowski

20 : Active

09/30/2022 3431 PLP3, PREC

20 : Clear

4159 Nursing Home Ad

9 : West Palm Beach

Palm Beach

551 CRESTA CR

FL 33413WEST PALM BEACH

801 [email protected]

PL11/23/1999Ernande

Fortune

20 : Active

09/30/2022 3342 PLP3, PREC

20 : Clear

4160 Nursing Home Ad

11 : Miami

Miami-Dade

3235 NE 184th ST

#11306 FL 33160-4910

AVENTURA

801 [email protected]

PL11/23/1999 732-759-4165

Steven Robert Furman

20 : Active

09/30/2022 3300 PLP3, PREC

20 : Clear

4165 Nursing Home Ad

6 : Tampa

Polk 1001 CARPENTER'S WAY

FL 33809LAKELAND

801 [email protected]

PL11/23/1999Mr. Brian Lee Robare

20 : Active

09/30/2022 3434 PLP3, PREC

20 : Clear

4167 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/23/1999 (850) 488-0595

Mr. Neil Sutton

20 : Active

09/30/2022 3390 PLP3, PREC

20 : Clear

4172 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/23/1999 (850) 488-0595

Mr. Everton M Spencer Sr.

20 : Active

09/30/2022 3361 PLP3, PREC

20 : Clear

4173 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/23/1999 (850) 488-0595

Gary R Lackey

20 : Active

09/30/2022 3386 BGSU, PLP3, PREC

20 : Clear

4186 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL2/7/2000 (850) 488-0595

Mr. Stephen B Parke

20 : Active

09/30/2022 3484 PLP3, PREC

20 : Clear

4189 Nursing Home Ad

9 : West Palm Beach

Palm Beach

7578 CHESTER TERRACE

FL 33433BOCA RATON

801 [email protected]

PL2/14/2000 (561) 756-1177

Mr Seth Daniel Wiesel

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 16 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 3592 PLP3, PREC

20 : Clear

4191 Nursing Home Ad

4 : jacksonville

St.Johns 3648 UNIVERSITY BLVD. SOUTH

FL 33216JACKSONVILLE

801 [email protected]

PL2/18/2000 904-733-7440

Ms. Connie Michele O'Donnell

20 : Active

09/30/2022 3591 PLP3, PREC

20 : Clear

4194 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL3/22/2000 (850) 488-0595

Mr. Mark Stephenson

Niemeyer

20 : Active

09/30/2022 3606 PLP3, PREC

20 : Clear

4202 Nursing Home Ad

10 : Ft. Lauderdale

Broward 2675 N. Andrews Avenue

FL 33334WILTON MANORS

801 [email protected]

PL5/4/2000 (954)563-5711

Ms. Maria Garcia Albury

20 : Active

09/30/2022 3604 PLP3, PREC

20 : Clear

4209 Nursing Home Ad

4 : jacksonville

Clay 797 Arthur Moore Drive

FL 32043GREEN COVE SPRINGS

801 [email protected]

PL5/5/2000 (850) 488-0595

Christopher

Deyo Green

20 : Active

09/30/2022 3612 PLP3, PREC

20 : Clear

4211 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL5/5/2000 (850) 488-0595

Nha Susan N Riddell

20 : Active

09/30/2022 3603 PLP3, PREC

20 : Clear

4215 Nursing Home Ad

7 : Orlando

Seminole 101 Sunnytown Road Suite 201

FL 32707CASSELBERRY

801 [email protected]

PL5/16/2000 407-830-5309

Tracy Nicole Greene

20 : Active

09/30/2022 3499 PLP3, PREC

20 : Clear

4233 Nursing Home Ad

3 : Gainesville

Lake 746 Oaks Shores Road

FL 34748LEESBURG

801 [email protected]

PL8/16/2000 (727) 417-2518

Theresa Guevara

Chang

20 : Active

09/30/2022 3637 PLP3, PREC

20 : Clear

4253 Nursing Home Ad

5 : St. Petersburg

Sarasota 832 SUNSET LAKE BLVD.

FL 34292VENICE801 [email protected]

PL10/31/2000 941-492-5313

Mr. Michael Todd Allen

20 : Active

09/30/2022 3672 PLP3, PREC

20 : Clear

4256 Nursing Home Ad

9 : West Palm Beach

Palm Beach

113 Old Jupiter Beach Road

FL 33477JUPITER

801 [email protected]

PL11/15/2000 (561) 346-4912

Mrs Stacy Lyn Valdivia

20 : Active

09/30/2022 3681 PLP3, PREC

20 : Clear

4260 Nursing Home Ad

6 : Tampa

Polk 919 OLD WINTER HAVEN RD

FL 33823AUBURNDALE

801 [email protected]

PL12/1/2000Mr. Michael Thomas Bradley

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 17 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 3677 PLP3, PREC

20 : Clear

4275 Nursing Home Ad

10 : Ft. Lauderdale

Broward 2000 E. COMMERCIAL BLVD.

FL 33308FT LAUDERDALE

801 [email protected]

PL4/16/2001 954-771-230

Mrs. Barbara Yanez-Artiles

20 : Active

09/30/2022 3732 PLP3, PREC

20 : Clear

4277 Nursing Home Ad

7 : Orlando

Orange 800 CONCOURSE PARKWAY S

FL 32751MAITLAND

801 [email protected]

PL5/7/2001 (786) 457-2383

Ms Miriam C Pastor

20 : Active

09/30/2022 3726 PLP3, PREC

20 : Clear

4286 Nursing Home Ad

5 : St. Petersburg

Sarasota 5381 DESOTO RD

FL 34235SARASOTA

801 [email protected]

PL5/9/2001 941-355-6111

Mr John Arthur Richards

20 : Active

09/30/2022 3733 PLP3, PREC

20 : Clear

4290 Nursing Home Ad

4 : jacksonville

Duval 1551 CRICHTON RD W.

FL 32221JACKSONVILLE

801 [email protected]

PL5/22/2001 904-786-7054

Melanie Polite Mcwhite

20 : Active

09/30/2022 3712 PLP3, PREC

20 : Clear

4296 Nursing Home Ad

11 : Miami

Miami-Dade

22550 SW 179 PLACE

FL 33170MIAMI801 [email protected]

PL5/24/2001 786-972-1400

Lucienne

Yamillee

Reese

20 : Active

09/30/2022 3738 PLP3, PREC

20 : Clear

4299 Nursing Home Ad

6 : Tampa

Polk 4192 Oak tree drive

FL 33837DAVENPORT

801 [email protected]

PL6/5/2001 863-280-4822

Nha Brenda Lee Davis

20 : Active

09/30/2022 3695 PLP3, PREC

20 : Clear

4300 Nursing Home Ad

4 : jacksonville

Duval 9960 ATRIYM WAY

FL 32225JACKSONVILLE

801 [email protected]

PL7/27/2001 904-724-4001

Russell T Ward

20 : Active

09/30/2022 3753 PLP3, PREC

20 : Clear

4307 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL8/16/2001 (850) 488-0595

Mr John C Simmons

20 : Active

09/30/2022 3621 PLP3, PREC

20 : Clear

4313 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL8/21/2001 (850) 488-0595

Mr. Shawn M Perrigo

20 : Active

09/30/2022 3699 PLP3, PREC

20 : Clear

4314 Nursing Home Ad

3 : Gainesville

Alachua 227 SW 62nd Blvd

FL 32607GAINESVILLE

801 [email protected]

PL8/21/2001 (352) 331-0601

Kala J. Fuhrmann

20 : Active

09/30/2022 3691 PLP3, PREC

20 : Clear

4325 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/6/2001 (850) 488-0595

Mr. Matt Thomas Triplett

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 18 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 3720 PLP3, PREC

20 : Clear

4330 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/7/2001 (850) 488-0595

Scott Howard Smith

20 : Active

09/30/2022 3719 PLP3, PREC

20 : Clear

4337 Nursing Home Ad

3 : Gainesville

Alachua 10104 SW 84 TERR

FL 32608GAINESVILLE

801 [email protected]

PL11/19/2001 (352) 215-7465

Mrs. Anita Elaine Howard

20 : Active

09/30/2022 3729 PLP3, PREC

20 : Clear

4340 Nursing Home Ad

5 : St. Petersburg

Pinellas 3301 N. MCMULLEN BOOTH RD

FL 33761CLEARWATER

801 [email protected]

PL11/19/2001 727-785-8335

John David Fitts

20 : Active

09/30/2022 3777 PLP3, PREC

20 : Clear

4341 Nursing Home Ad

11 : Miami

Miami-Dade

19590 OLD CUTLER ROAD

FL 33157CUTLER BAY

801 [email protected]

PL11/19/2001 786-466-3500

Karin Jane Di Piero

20 : Active

09/30/2022 3758 PLP3, PREC

20 : Clear

4346 Nursing Home Ad

4 : jacksonville

Volusia 62 Mayfield Circle

FL 32174ORMOND BEACH

801 [email protected]

PL2/1/2002 386-566-4150

Perry James Weiker

20 : Active

09/30/2022 3470 PLP3, PREC

20 : Clear

4356 Nursing Home Ad

6 : Tampa

Hillsborough

1010 American Eagle Blvd.

FL 33573SUN CITY CENTER

801 [email protected]

PL2/14/2002 813-633-3066

Christopher

Grella

20 : Active

09/30/2022 3809 PLP3, PREC

20 : Clear

4359 Nursing Home Ad

5 : St. Petersburg

Pinellas 3480 N. McMullen Booth Road

FL 33761CLEARWATER

801 [email protected]

PL2/20/2002 727-786-6697

Sandra Kirkland Hill

20 : Active

09/30/2022 3844 PLP3, PREC

20 : Clear

4371 Nursing Home Ad

5 : St. Petersburg

Pinellas 7380 Ulmerton Rd.

FL 33771LARGO801 [email protected]

PL5/30/2002 727-535-9833

Ms. Theresa Marie Felicione

20 : Active

09/30/2022 3843 PLP3, PREC

20 : Clear

4375 Nursing Home Ad

7 : Orlando

Seminole 1120 Alberta Street

FL 32750LONGWOOD

801 [email protected]

PL6/19/2002 407-832-6153

Nha Kimberly

Sherman

Boudrie

20 : Active

09/30/2022 3832 PLP3, PREC

20 : Clear

4376 Nursing Home Ad

9 : West Palm Beach

Palm Beach

2105 SW. 11TH COURT

FL 33445DELRAY BEACH

801 [email protected]

PL6/20/2002 561-454-1132

Amin Sanaia

20 : Active

09/30/2022 3829 PLP3, PREC

20 : Clear

4377 Nursing Home Ad

9 : West Palm Beach

Palm Beach

5065 Wallis Road

FL 33415WEST PALM BEACH

801 [email protected]

PL6/25/2002 561-689-1799

Kim Ann Delplato

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 19 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 3850 PLP3, PREC

20 : Clear

4381 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL7/22/2002 (850) 488-0595

Brian Thomas Mccoy

20 : Active

09/30/2022 3860 PLP3, PREC

20 : Clear

4388 Nursing Home Ad

6 : Tampa

Polk 131 Van Fleet Ct

FL 33823AUBURNDALE

801 [email protected]

PL8/2/2002 561-866-9936

Victoria Lea Duvall

20 : Active

09/30/2022 3853 PLP3, PREC

20 : Clear

4396 Nursing Home Ad

9 : West Palm Beach

Palm Beach

7225 Boca Del Mar Dr

FL 33433BOCA RATON

801 [email protected]

PL8/12/2002Mrs. Janet Dadia

20 : Active

09/30/2022 3752 PLP3, PREC

20 : Clear

4400 Nursing Home Ad

10 : Ft. Lauderdale

Broward 3370 nw 47th terrace

Lauderdale Lakesx

FL 33319LAUDERDALE LAKES

801 [email protected]

PL8/30/2002 954-733-0655

Karlene Victoria Case

20 : Active

09/30/2022 3708 PLP3, PREC

20 : Clear

4401 Nursing Home Ad

7 : Orlando

Brevard 175 Villa Nueva Avenue

FL 32907PALM BAY

801 [email protected]

PL9/3/2002 321-952-1818

Willard E Tarbet II

20 : Active

09/30/2022 3910 PLP3, PREC

20 : Clear

4408 Nursing Home Ad

3 : Gainesville

Lake 2810 RULEME STREET

FL 32726EUSTIS801 [email protected]

PL10/28/2002 352-537-1990

Chad William Hurta

20 : Active

09/30/2022 3892 PLP3, PREC

20 : Clear

4413 Nursing Home Ad

7 : Orlando

Orange Hunter's Creek Nursing & rehab

14155 Town Loop Blvd.

FL 32837ORLANDO

801 [email protected]

PL11/5/2002 1(407)541-2600

Randall Gregory Blue

20 : Active

09/30/2022 3830 PLP3, PREC

20 : Clear

4421 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL12/4/2002 (850) 488-0595

Mrs. Rachel Schuster

20 : Active

09/30/2022 3887 PLP3, PREC

20 : Clear

4424 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL12/4/2002 (850) 488-0595

Admi Brenda Sue Hebden

20 : Active

09/30/2022 3798 PLP3, PREC

20 : Clear

4434 Nursing Home Ad

5 : St. Petersburg

Manatee 2004 78TH STREET NW

FL 34209BRADENTON

801 [email protected]

PL1/17/2003 (561) 281-6156

Mrs Kimberly

F Morrow

20 : Active

09/30/2022 3907 PLP3, PREC

20 : Clear

4435 Nursing Home Ad

5 : St. Petersburg

Pinellas 7101 DR. MARTIN LUTHER KING ST. N.

FL 33702SAINT PETERSBURG

801 [email protected]

PL2/10/2003 727-522-2486

Kimberly

Devonne

Cloud

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 20 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 3780 PLP3, PREC

20 : Clear

4436 Nursing Home Ad

11 : Miami

Miami-Dade

2500 N.W. 22ND AVE

FL 33142MIAMI801 [email protected]

PL2/10/2003 (786) 466-3000

Ms. Maria N Mayor

20 : Active

09/30/2022 3949 PLP3, PREC

20 : Clear

4448 Nursing Home Ad

1 : Pensacola

Escambia 3291 EAST OLIVE ROAD

FL 32514PENSACOLA

801 [email protected]

PL3/27/2003 850-494-2327

Ms. Jennifer Susan Landis

20 : Active

09/30/2022 3959 PLP3, PREC

20 : Clear

4453 Nursing Home Ad

7 : Orlando

Brevard 2355 Vidina Dr.

FL 32940VIERA801 [email protected]

PL3/27/2003 (321)775-6800

Ms Mildred H Sorger

20 : Active

09/30/2022 3897 PLP3, PREC

20 : Clear

4458 Nursing Home Ad

5 : St. Petersburg

Pinellas 3127 57th Ave N

FL 33714SAINT PETERSBURG

801 [email protected]

PL4/17/2003 727-527-2171

Mr. Reginal Wayne Washington

20 : Active

09/30/2022 3969 PLP3, PREC

20 : Clear

4471 Nursing Home Ad

10 : Ft. Lauderdale

Broward 10255 CAMAILLA ST.

FL 33076PARKLAND

801 [email protected]

PL6/17/2003 954-437-3422

Mr. Ken C Angel

20 : Active

09/30/2022 3953 PLP3, PREC

20 : Clear

4476 Nursing Home Ad

8 : Ft. Myers

Collier 2135 RATTLESNAKE HAMMOCK RD.

FL 34117NAPLES801 [email protected]

PL6/17/2003 239-775-7715

Mr. Javier Cavero

20 : Active

09/30/2022 3890 PLP3, PREC

20 : Clear

4477 Nursing Home Ad

11 : Miami

Miami-Dade

13650 NE THIRD CT

PINECREST REHABILITATION CENTER

FL 33161NORTH MIAMI

801 [email protected]

PL6/17/2003 305-893-1170

Mr. David C Gold

20 : Active

09/30/2022 3989 PLP3, PREC

20 : Clear

4478 Nursing Home Ad

3 : Gainesville

Alachua 7207 SW. 24TH AVENUE

FL 32607GAINESVILLE

801 [email protected]

PL6/19/2003 352-333-0600

Mr David A Keighley

20 : Active

09/30/2022 3881 PLP3, PREC

20 : Clear

4479 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL7/9/2003 (850) 488-0595

Jeffrey Ryan Thomas

20 : Active

09/30/2022 3984 PLP3, PREC

20 : Clear

4482 Nursing Home Ad

8 : Ft. Myers

Lee 16131 ROSE RUSH COURT

FL 33908FT MYERS

801 [email protected]

PL7/31/2003 239-343-7300

Leslie Stuart Vollmer

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801 : Nursing Home AdministratorPage 21 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 3909 PLP3, PREC

20 : Clear

4484 Nursing Home Ad

7 : Orlando

Seminole 323 Bellview Place

FL 32771SANFORD

801 [email protected]

PL7/31/2003 352-735-6165

Terri Lynn Amitrone

20 : Active

09/30/2022 3617 PLP3, PREC

20 : Clear

4490 Nursing Home Ad

7 : Orlando

Orange 626 English Lake Drive

FL 34787WINTER GARDEN

801 [email protected]

PL7/31/2003 561-271-8991

Mr. David Lenny Randazzo

20 : Active

09/30/2022 4016 PLP3, PREC

20 : Clear

4506 Nursing Home Ad

8 : Ft. Myers

Highlands 1010 US 27 NORTH

0 FL 33825AVON PARK

801 [email protected]

PL9/19/2003 863 453-5200

Mr James V Spadola

20 : Active

09/30/2022 3957 PLP3, PREC

20 : Clear

4512 Nursing Home Ad

4 : jacksonville

Duval 5355 DOLPHIN POINT BLVD

FL 32211JACKSONVILLE

801 [email protected]

PL9/19/2003 904-914-8801

Salvatore

Antonio Decaria

20 : Active

09/30/2022 3921 PLP3, PREC

20 : Clear

4524 Nursing Home Ad

2 : Tallahassee

Jackson 4294 THIRD AVENUE

FL 32446MARIANNA

801 [email protected]

PL11/7/2003 850-209-7172

Kimberly

Renee Bradley-Hamilton

20 : Active

09/30/2022 4010 PLP3, PREC

20 : Clear

4526 Nursing Home Ad

6 : Tampa

Hillsborough

851 W. LUMSDEN

FL 33511BRANDON

801 [email protected]

PL11/7/2003 813-661-8998

Joseph John Cassiba

20 : Active

09/30/2022 3926 PLP3, PREC

20 : Clear

4527 Nursing Home Ad

0 : None Out Of State

1000 Branchwood Drive

NC 27284KERNERSVILLE

801 [email protected]

PL11/19/2003 (7726338705

Mrs Jennifer Stinnett Jasper

20 : Active

09/30/2022 3826 PLP3, PREC

20 : Clear

4528 Nursing Home Ad

11 : Miami

Miami-Dade

7600 S.W. 8TH STREET

FL 33144MIAMI801 [email protected]

PL11/19/2003 305-261-2525

Mrs. Monica Marie Calonge

20 : Active

09/30/2022 4032 PLP3, PREC

20 : Clear

4532 Nursing Home Ad

8 : Ft. Myers

Charlotte 25325 RAMPART BOULEVARD

FL 33983PORT CHARLOTTE

801 [email protected]

PL12/4/2003 941-629-7466

Ms Heather Anne Szmigiel

20 : Active

09/30/2022 3997 PLP3, PREC

20 : Clear

4533 Nursing Home Ad

3 : Gainesville

Citrus 6208 W CORPORATE OAKS DR

FL 34429CRYSTAL RIVER

801 [email protected]

PL12/16/2003Mr. Brian Andrew Perine

20 : Active

09/30/2022 4036 PLP3, PREC

20 : Clear

4534 Nursing Home Ad

5 : St. Petersburg

Pinellas 870 PATRICIA AVE

FL 34698DUNEDIN

801 [email protected]

PL1/9/2004 727-734-8861

Turner M Byrd

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801 : Nursing Home AdministratorPage 22 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 4039 PLP3, PREC

20 : Clear

4543 Nursing Home Ad

3 : Gainesville

Columbia 298 SW Prosperity Place

FL 32024LAKE CITY

801 [email protected]

PL2/4/2004 (386)269-3900

Ms Brenda Kay Lacy

20 : Active

09/30/2022 4059 PLP3, PREC

20 : Clear

4550 Nursing Home Ad

9 : West Palm Beach

Palm Beach

4733 NW Seventh Court

FL 33426BOYNTON BEACH

801 [email protected]

PL3/18/2004 (561) 257-4730

Mr. James Ryar Burns

20 : Active

09/30/2022 4015 PLP3, PREC

20 : Clear

4551 Nursing Home Ad

8 : Ft. Myers

Charlotte 2370 Harbor Boulevard

Florida FL 33952PORT CHARLOTTE

801 [email protected]

PL3/18/2004 941-624-5966

Mr Lee Coyne Edmister

20 : Active

09/30/2022 4061 PLP3, PREC

20 : Clear

4555 Nursing Home Ad

0 : None Out Of State

115 Sentinel Ridge

SC 29627BELTON801 [email protected]

PL5/5/2004 904-304-0484

Mr Brian C Jenkins

20 : Active

09/30/2022 3980 PLP3, PREC

20 : Clear

4569 Nursing Home Ad

7 : Orlando

Osceola 1700 Monroe Avenue

FL 32751MAITLAND

801 [email protected]

PL7/15/2004 407-647-2092

Donald W Daniels

20 : Active

09/30/2022 4099 PLP3, PREC

20 : Clear

4580 Nursing Home Ad

5 : St. Petersburg

Pinellas 4470 EAST BAY DRIVE

FL 33764CLEARWATER

801 [email protected]

PL7/26/2004 727-530-7100

Mr Jason Peraltza Canlas

20 : Active

09/30/2022 4021 PLP3, PREC

20 : Clear

4581 Nursing Home Ad

6 : Tampa

Pasco 6140 CONGRESS STREET

FL 34653NEW PORT RICHEY

801 [email protected]

PL7/26/2004 727-842-8402

Mrs Kimberly

Ann Vermilyea

20 : Active

09/30/2022 4123 PLP3, PREC

20 : Clear

4590 Nursing Home Ad

7 : Orlando

Osceola 4641 OLD CANOE CREEK RD.

FL 34769SAINT CLOUD

801 [email protected]

PL9/9/2004 407-892-7344

Elena Carolina Desmond

20 : Active

09/30/2022 4137 PLP3, PREC

20 : Clear

4598 Nursing Home Ad

4 : jacksonville

St.Johns 200 MARINER HEALTH WAY

FL 32086SAINT AUGUSTINE

801 [email protected]

PL10/1/2004 904-797-1800

Mr Jason Lee Davis

20 : Active

09/30/2022 4131 PLP3, PREC

20 : Clear

4600 Nursing Home Ad

6 : Tampa

Polk 2120 MARSHALL EDWARDS DR

FL 33830BARTOW

801 [email protected]

PL10/1/2004 8635197579

Mrs Janet L. Dixon-Hanciles

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801 : Nursing Home AdministratorPage 23 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 4153 PLP3, PREC

20 : Clear

4605 Nursing Home Ad

7 : Orlando

Orange 7950 LAKE UNDERHILL ROAD

FL 32822ORLANDO

801 [email protected]

PL10/29/2004 407-312-5581

Ms. Terrie Elaine Banks

20 : Active

09/30/2022 4143 PLP3, PREC

20 : Clear

4608 Nursing Home Ad

9 : West Palm Beach

Palm Beach

2839 S. SEACREST BLVD.

FL 33435BOYNTON BEACH

801 [email protected]

PL11/18/2004 561-732-2464

Ms Donna-Lee

Fabian

20 : Active

09/30/2022 4106 PLP3, PREC

20 : Clear

4618 Nursing Home Ad

6 : Tampa

Pasco 8041 STATE ROAD 52

FL 34667HUDSON

801 [email protected]

PL1/26/2005 727-863-5488

Mrs Anna-Marie

Alma Owens-Wicker

20 : Active

09/30/2022 4064 PLP3, PREC

20 : Clear

4623 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL2/18/2005 (850) 488-0595

Donald Bruce Jones

20 : Active

09/30/2022 4054 PLP3, PREC

20 : Clear

4626 Nursing Home Ad

11 : Miami

Miami-Dade

12136 SW 255 Street

Homestead

FL 33032HOMESTEAD

801 [email protected]

PL3/7/2005 786-623-1007

Ms. Marta Delgado

20 : Active

09/30/2022 4088 PLP3, PREC

20 : Clear

4629 Nursing Home Ad

9 : West Palm Beach

Palm Beach

2090 N. CONGRESS AVE.

FL 33401WEST PALM BEACH

801 [email protected]

PL3/23/2005 561-686-5100

Ms. Heather Anne Langlais

20 : Active

09/30/2022 4202 PLP3, PREC

20 : Clear

4642 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL6/1/2005 (850) 488-0595

Matthew

Joseph Thompson

20 : Active

09/30/2022 4181 PLP3, PREC

20 : Clear

4644 Nursing Home Ad

8 : Ft. Myers

Collier 8000 ARLINGTON CIRCLE

FL 34113NAPLES801 [email protected]

PL6/7/2005 239-307-3000

Ms. Jennifer Lynn Grimes

20 : Active

09/30/2022 4168 PLP3, PREC

20 : Clear

4652 Nursing Home Ad

6 : Tampa

Pasco 8417 OLD COUNTY ROAD 54

FL 34653NEW PORT RICHEY

801 [email protected]

PL7/7/2005 (727) 376-1585

Mr. Daniel L Frenden

20 : Active

09/30/2022 4026 PLP3, PREC

20 : Clear

4655 Nursing Home Ad

11 : Miami

Miami-Dade

8785 NW 32 AVENUE

FL 33147MIAMI801 [email protected]

PL7/25/2005 (305) 691-5711

Isis Fernandez

20 : Active

09/30/2022 4031 PLP3, PREC

20 : Clear

4657 Nursing Home Ad

11 : Miami

Miami-Dade

2525 SW 75 AVE.

FL 33155MIAMI801 [email protected]

PL7/25/2005 305-265-0571

Louis Robert Perez

20 : Active

09/30/2022 4185 PLP3, PREC

20 : Clear

4660 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL8/19/2005 (850) 488-0595

Mr Henry Gerrity Iii

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801 : Nursing Home AdministratorPage 24 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 4156 PLP3, PREC

20 : Clear

4661 Nursing Home Ad

2 : Tallahassee

Leon 2995 PARK MEADOW DRIVE

FL 32703APOPKA

801 [email protected]

PL8/19/2005 (407)222-3889

Mrs Vereen Nicole Williams

20 : Active

09/30/2022 4221 PLP3, PREC

20 : Clear

4667 Nursing Home Ad

5 : St. Petersburg

Pinellas 3500 OAK MANOR LANE

FL 33774LARGO801 [email protected]

PL9/12/2005 (727) 581-9427

Michael Thomas Mcquilkin

20 : Active

09/30/2022 4232 PLP3, PREC

20 : Clear

4668 Nursing Home Ad

3 : Gainesville

Lake 700 N. PALMETTO ST.

FL 34748LEESBURG

801 [email protected]

PL9/19/2005 352-323-2400

Mr. Tristan Shiv Mohadeo

20 : Active

09/30/2022 4207 PLP3, PREC

20 : Clear

4669 Nursing Home Ad

7 : Orlando

Orange 70 W. LUCERNE CIR..

FL 32801ORLANDO

801 [email protected]

PL9/19/2005 407-841-1310

Mr. Lesly Mompoint

20 : Active

09/30/2022 3859 PLP3, PREC

20 : Clear

4670 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL9/19/2005 (850) 488-0595

Mrs Cara Lyn Spadola

20 : Active

09/30/2022 4148 PLP3, PREC

20 : Clear

4675 Nursing Home Ad

6 : Tampa

Hillsborough

3850 UPPER CREEK DRIVE

FL 33573SUN CITY CENTER

801 [email protected]

PL10/27/2005 813-633-2875

Brian D. Bentz

20 : Active

09/30/2022 4167 PLP3, PREC

20 : Clear

4677 Nursing Home Ad

9 : West Palm Beach

Palm Beach

5065 WALLIS AD.

FL 33415WEST PALM BCH

801 [email protected]

PL10/31/2005 561-689-1799

Mr. Roy Douglas Cruce

20 : Active

09/30/2022 4250 PLP3, PREC

20 : Clear

4684 Nursing Home Ad

10 : Ft. Lauderdale

Broward 9711 W. Oakland Park Blvd

FL 33351SUNRISE

801 [email protected]

PL12/2/2005 954-572-4000

Nha Maria Caridad Hernandez

20 : Active

09/30/2022 4203 PLP3, PREC

20 : Clear

4685 Nursing Home Ad

5 : St. Petersburg

Pinellas 1414 59TH ST. S.

FL 33707GULFPORT

801 [email protected]

PL12/2/2005 727-344-4608

Danny M Davis

20 : Active

09/30/2022 4089 GENR, PLP3, PREC

20 : Clear

4689 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL12/13/2005 (850) 488-0595

Mr. Zev Shemesh

20 : Active

09/30/2022 4278 PLP3, PREC

20 : Clear

4696 Nursing Home Ad

8 : Ft. Myers

Highlands 125 TOMOKA BLVD. S.

FL 33852LAKE PLACID

801 [email protected]

PL1/11/2006 863-465-7200

Mr Jean-Marc

Ulysse

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 25 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 4133 PLP3, PREC

20 : Clear

4702 Nursing Home Ad

9 : West Palm Beach

Palm Beach

23315 BLUE WATER CIRCLE

FL 33433BOCA RATON

801 [email protected]

PL1/26/2006 561-391-6305

Ms. Aimee Michelle Hilton

20 : Active

09/30/2022 4208 AIT, PLP3, PREC

20 : Clear

4703 Nursing Home Ad

9 : West Palm Beach

Palm Beach

2792 DONNELLY DRIVE

FL 33462LANTANA

801 [email protected]

PL2/3/2006 561-434-5362

Mrs Lashundria

T Gavin

20 : Active

09/30/2022 4273 PLP3, PREC

20 : Clear

4705 Nursing Home Ad

9 : West Palm Beach

Martin 1500 S.W. CAPRI ST.

FL 34990PALM CITY

801 [email protected]

PL2/3/2006 772-223-6120

Erin Rachel Montegut

20 : Active

09/30/2022 4274 PLP3, PREC

20 : Clear

4711 Nursing Home Ad

4 : jacksonville

Volusia 142 Crystal Oak Drive

FL 32720DELAND801 [email protected]

PL3/7/2006 (386) 259-3478

Jenny R George

20 : Active

09/30/2022 4313 PLP2, PLP3, PREC

20 : Clear

4729 Nursing Home Ad

7 : Orlando

Seminole VILLAGE ON THE GREEN

500 VILLAGE PLACE

FL 32779LONGWOOD

801 [email protected]

PL5/2/2006 407-682-0230

Ms Yolanda Gail Wattley

20 : Active

09/30/2022 4112 PLP3, PREC

20 : Clear

4735 Nursing Home Ad

1 : Pensacola

Washington

879 USERY ROAD

FL 32428CHIPLEY

801 [email protected]

PL6/9/2006 8506384654

Robert H Brown

20 : Active

09/30/2022 4323 PLP3, PREC

20 : Clear

4736 Nursing Home Ad

4 : jacksonville

Volusia 901 VETERANS MEMORIAL PKWY.

FL 32763ORANGE CITY

801 [email protected]

PL6/9/2006 386-775-2008

Ms. Christa Louise Vaughan

20 : Active

09/30/2022 4254 PLP3, PREC

20 : Clear

4751 Nursing Home Ad

6 : Tampa

Hillsborough

9644 GREENBANK DR

FL 33569RIVERVIEW

801 [email protected]

PL9/6/2006 813-651-1818

Elizabeth

Clara Donfila

20 : Active

09/30/2022 4289 PLP3, PREC

20 : Clear

4758 Nursing Home Ad

4 : jacksonville

Duval 2061 HYDE PARK ROAD

FL 32210JACKSONVILLE

801 [email protected]

PL10/25/2006 904-786-7331

Mrs Gwendolyn

Strunk Gamel

20 : Active

09/30/2022 4338 PLP3, PREC

20 : Clear

4761 Nursing Home Ad

10 : Ft. Lauderdale

Broward 911 SE 5TH TERRACE

FL 33060POMAPNO BEACH

801 [email protected]

PL11/6/2006 954-654-4000

Mr John Steven Glass

20 : Active

09/30/2022 4367 PLP3, PREC

20 : Clear

4763 Nursing Home Ad

7 : Orlando

Seminole 830 W, 29th Street

FL 32805ORLANDO

801 [email protected]

PL11/16/2006 407-843-3430

Mr. Trentino Anthony Manco

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801 : Nursing Home AdministratorPage 26 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 4355 PLP3, PREC

20 : Clear

4764 Nursing Home Ad

11 : Miami

Miami-Dade

9380 NW 7TH AVE

FL 33150MIAMI801 [email protected]

PL11/16/2006 305-759-8711

Miss Maureen

Brown

20 : Active

09/30/2022 4382 PLP3, PREC

20 : Clear

4770 Nursing Home Ad

4 : jacksonville

St.Johns 230 TAVERVIEW DR.

FL 32092SAINT AUGUSTINE

801 [email protected]

PL12/29/2006 904-940-4801

Marilyn B Cameron

20 : Active

09/30/2022 4246 PLP3, PREC

20 : Clear

4774 Nursing Home Ad

6 : Tampa

Hillsborough

11010 Charmwood Drive

FL 33569RIVERVIEW

801 [email protected]

PL2/7/2007 954-336-2231

Mrs. Darmilia Samantha

Bailey

20 : Active

09/30/2022 4371 PLP3, PREC

20 : Clear

4775 Nursing Home Ad

4 : jacksonville

Clay 201 NOTTINGHAM DR W

FL 32259JACKSONVILLE

801 [email protected]

PL2/14/2007 251 - 689 - 5475

Mr James David Prater

20 : Active

09/30/2022 4334 PLP3, PREC

20 : Clear

4776 Nursing Home Ad

3 : Gainesville

Columbia 560 SW MCFARLANE AVE

FL 32025LAKE CITY

801 [email protected]

PL2/16/2007 386-758-4777

Patricia Ellen Delrio

20 : Active

09/30/2022 4315 PLP3, PREC

20 : Clear

4779 Nursing Home Ad

9 : West Palm Beach

Palm Beach

1425 SOUTH CONGRESS AVE.

FL 33426BOYNTON BEACH

801 [email protected]

PL3/29/2007 561-369-7919

Admi Janet Lynn Hansen

20 : Active

09/30/2022 4383 PLP3, PREC

20 : Clear

4780 Nursing Home Ad

5 : St. Petersburg

Manatee 926 HABEN BLVD.

FL 34221PALMETTO

801 [email protected]

PL3/29/2007 941-722-0553

Frederick

Joseph Landy

20 : Active

09/30/2022 4427 PLP3, PREC

20 : Clear

4800 Nursing Home Ad

7 : Orlando

Orange 487 BELLE FERN CT

FL 34761OCOEE801 [email protected]

PL6/13/2007 407-975-3800

Kimbella

Evette Lane

20 : Active

09/30/2022 4314 PLP3, PREC

20 : Clear

4803 Nursing Home Ad

5 : St. Petersburg

Manatee 2302 59TH STREET WEST

FL 34209BRADENTON

801 [email protected]

PL6/22/2007 941-792-8480

Kimberly

Brennick

20 : Active

09/30/2022 4265 PLP3, PREC

20 : Clear

4809 Nursing Home Ad

4 : jacksonville

Clay 2040 Town Center Blvd

FL 32003FLEMING ISLAND

801 [email protected]

PL7/3/2007 (850) 488-0595

Eric J. Weisz

20 : Active

09/30/2022 4375 PLP3, PREC

20 : Clear

4816 Nursing Home Ad

9 : West Palm Beach

St.Lucie 1800 SE HILLMOOR DRIVE

FL 34952PORT SAINT LUCIE

801 [email protected]

PL8/8/2007 (772) 337-3565

Lnha Dianne Marie O'Sullivan

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801 : Nursing Home AdministratorPage 27 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 4345 PLP3, PREC

20 : Clear

4821 Nursing Home Ad

3 : Gainesville

Marion 9280 SW 81ST CT.

FL 34481OCALA801 [email protected]

PL9/20/2007 352-433-1700

Mrs. Janice Lucille Myers

20 : Active

09/30/2022 4364 PLP3, PREC

20 : Clear

4825 Nursing Home Ad

6 : Tampa

Polk 1001 Carpenters Way

FL 33809LAKELAND

801 [email protected]

PL9/25/2007 863-858-3847

Matthew

Joseph Thompson

20 : Active

09/30/2022 4446 PLP3, PREC

20 : Clear

4830 Nursing Home Ad

5 : St. Petersburg

Sarasota The Glenridge on Palmer Ranch

7333 Scotland Way

FL 34238SARASOTA

801 [email protected]

PL11/14/2007Julie Maslinski

Irvin

20 : Active

09/30/2022 4311 PLP3, PREC

20 : Clear

4840 Nursing Home Ad

9 : West Palm Beach

Palm Beach

601 UNIVERSE BLVD.

FL 33408JUNO BEACH

801 [email protected]

PL12/20/2007 561-627-3800

Ms Nashika Tamou Jackson O'Gilvie

20 : Active

09/30/2022 4264 PLP3, PREC

20 : Clear

4851 Nursing Home Ad

4 : jacksonville

Duval 4134 DUNN AVENUE

FL 32216JACKSONVILLE

801 PL1/23/2008 904-757-0600

Jason Mathew Kallen

20 : Active

09/30/2022 4435 PLP3, PREC

20 : Clear

4853 Nursing Home Ad

2 : Tallahassee

Leon 2255 Centerville Rd.

FL 32308TALLAHASSEE

801 [email protected]

PL2/29/2008 850-386-4054

Ronald Edison Reid

20 : Active

09/30/2022 4428 PLP3, PREC

20 : Clear

4859 Nursing Home Ad

6 : Tampa

Pasco 2739 Blueslate Court

FL 34638LAND O LAKES

801 [email protected]

PL3/25/2008 813-323-5839

Ms. Margaret

Elizabeth

Dalton

20 : Active

09/30/2022 4300 PLP3, PREC

20 : Clear

4860 Nursing Home Ad

11 : Miami

Miami-Dade

18905 NE 25th Avenue

FL 33180AVENTURA

801 [email protected]

PL3/25/2008 305-932-6360

Mr. Menashe

Eliyahu Sapirman

20 : Active

09/30/2022 4516 PLP3, PREC

20 : Clear

4868 Nursing Home Ad

5 : St. Petersburg

Pinellas 6025 Sun Blvd

Apt 302 FL 33715SAINT PETERSBURG

801 [email protected]

PL4/14/2008Mrs. Erin Olivia Blakely

20 : Active

09/30/2022 4515 PLP3, PREC

20 : Clear

4870 Nursing Home Ad

9 : West Palm Beach

Palm Beach

4847 FRED GLADSTONE DR

FL 33417WEST PALM BEACH

801 [email protected]

PL4/14/2008 561-687-5744

Mr. Keith A Myers

20 : Active

09/30/2022 4461 PLP3, PREC

20 : Clear

4872 Nursing Home Ad

6 : Tampa

Polk 909 LAKESIDE AVE

FL 33803LAKELAND

801 [email protected]

PL4/22/2008 863-577-6051

Ms Maria Esther Rivera

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801 : Nursing Home AdministratorPage 28 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 4536 PLP3, PREC

20 : Clear

4873 Nursing Home Ad

10 : Ft. Lauderdale

Broward 7901 Nw 88th AVENUE

FL 33321TAMARAC

801 [email protected]

PL4/28/2008 954-722-9330

Mrs. Nicola Chandler

Byam

20 : Active

09/30/2022 4522 PLP3, PREC

20 : Clear

4879 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL5/12/2008 (850) 488-0595

Mrs. Denise Marie Caiati

20 : Active

09/30/2022 4262 PLP3, PREC

20 : Clear

4880 Nursing Home Ad

7 : Orlando

Brevard 1775 HUNTINGTON LANE

FL 32955ROCKLEDGE

801 [email protected]

PL5/12/2008 321-632-7341

Jessica Renee Pierre

20 : Active

09/30/2022 4547 PLP3, PREC

20 : Clear

4882 Nursing Home Ad

0 : None Out Of State

9789 Black Willow Ln

SC 29456LADSON

801 [email protected]

PL5/15/2008 843-991-5036

Mr. Louis L Kass

20 : Active

09/30/2022 4475 PLP3, PREC

20 : Clear

4894 Nursing Home Ad

6 : Tampa

Hillsborough

101 TRINITY LAKES DRIVE

FL 33573SUN CITY CENTER

801 [email protected]

PL7/11/2008 813-634-3324

Alexander

Jason Kusmierz

20 : Active

09/30/2022 4477 PLP3, PREC

20 : Clear

4897 Nursing Home Ad

8 : Ft. Myers

Collier 9202 MUSEO CIRCLE

APT103 FL 34114NAPLES801 [email protected]

PL7/21/2008Jennifer Lynn Iavarone

20 : Active

09/30/2022 4346 PLP3, PREC

20 : Clear

4900 Nursing Home Ad

3 : Gainesville

Suwannee

10676 Marvin Jones Blvd

FL 32060LIVE OAK

801 [email protected]

PL8/11/2008 386-658-5550

Mrs. Keri Elizabeth

Hilliard

20 : Active

09/30/2022 4579 PLP3, PREC

20 : Clear

4904 Nursing Home Ad

6 : Tampa

Hernando 12170 Cortez Blvd

FL 34613BROOKSVILLE

801 [email protected]

PL8/28/2008 (352) 597-5100

Mr. Derek Goebelbecker

Webster

20 : Active

09/30/2022 4556 PLP3, PREC

20 : Clear

4905 Nursing Home Ad

11 : Miami

Monroe 48 HIGH POINT RD

FL 33070TAVERNIER

801 [email protected]

PL9/22/2008 305-853-0799

Trevor Stewart Matchim

20 : Active

09/30/2022 4589 PLP3, PREC

20 : Clear

4910 Nursing Home Ad

4 : jacksonville

Duval 11565 HARTS ROAD

FL 32218JACKSONVILLE

801 [email protected]

PL11/7/2008 904-751-1834

Larry Mann

20 : Active

09/30/2022 4600 PLP3, PREC

20 : Clear

4913 Nursing Home Ad

6 : Tampa

Pasco 900 BECKETT WAY

FL 34691TARPON SPRINGS

801 [email protected]

PL11/21/2008 727-403-5468

Mrs Ryan Brytni Dulski

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801 : Nursing Home AdministratorPage 29 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 4495 PLP3, PREC

20 : Clear

4914 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/21/2008 (850) 488-0595

Ms. Cherlyn Mary Deleonabreu

20 : Active

09/30/2022 4583 PLP3, PREC

20 : Clear

4925 Nursing Home Ad

5 : St. Petersburg

Hardee 401 401 Orange Place

FL 33873WAUCHULA

801 [email protected]

PL1/8/2009 863-773-3231

Patricia Lasseter

Spears

20 : Active

09/30/2022 4591 PLP3, PREC

20 : Clear

4927 Nursing Home Ad

5 : St. Petersburg

Pinellas 400 CORBETT ST.

FL 33756BELLEAIR

801 [email protected]

PL1/16/2009 727-462-7609

Ms. Maya T. Perez

20 : Active

09/30/2022 4537 PLP3, PREC

20 : Clear

4928 Nursing Home Ad

4 : jacksonville

Clay 1589 LONG HORN RD.

FL 32068MIDDLEBURG

801 [email protected]

PL1/23/2009 (502) 216-6568

Mrs Alexandria

E Russell

20 : Active

09/30/2022 4523 PLP3, PREC

20 : Clear

4945 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL6/1/2009 (850) 488-0595

Brian Scott Jackson

20 : Active

09/30/2022 4573 PLP3, PREC

20 : Clear

4946 Nursing Home Ad

4 : jacksonville

Volusia 170 N. CENTER ST.

FL 32174ORMOND BEACH

801 [email protected]

PL6/5/2009 386-672-7113

Donna J Smith

20 : Active

09/30/2022 4637 PLP3, PREC

20 : Clear

4951 Nursing Home Ad

6 : Tampa

Polk 4382 MANDOLIN BLVD

FL 33884WINTER HAVEN

801 [email protected]

PL6/25/2009 850-405-0953

Ellis J Williams

20 : Active

09/30/2022 4576 PLP3, PREC

20 : Clear

4952 Nursing Home Ad

4 : jacksonville

Flagler 3001 PALM COAST PARKWAY SE.

FL 32136FLAGLER BEACH

801 [email protected]

PL6/25/2009 386-446-6060

Heather Christine

Jackson

20 : Active

09/30/2022 4607 PLP3, PREC

20 : Clear

4957 Nursing Home Ad

9 : West Palm Beach

Palm Beach

5101 W. BLUE HERON BLVD

FL 33418RIVIERA BEACH

801 [email protected]

PL7/13/2009 561-842-6111

Shelly Ann Lau

20 : Active

09/30/2022 4513 PLP3, PREC

20 : Clear

4961 Nursing Home Ad

5 : St. Petersburg

Manatee 5627 9TH STREET EAST

FL 34203BRADENTON

801 [email protected]

PL7/29/2009 941-753-8941

Mr. Steven William Oelfke

20 : Active

09/30/2022 4419 PLP3, PREC

20 : Clear

4962 Nursing Home Ad

7 : Orlando

Orange 1556 MAGUIRE RD

FL 34761OCOEE801 [email protected]

PL8/7/2009 407-877-2272

Marie Posseh Kamara

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 30 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 4534 PLP3, PREC

20 : Clear

4968 Nursing Home Ad

4 : jacksonville

Duval 4000 SAN PABLO PKWY

FL 32224JACKSONVILLE

801 [email protected]

PL8/13/2009 904-928-3700

Lisa Ellen Doerler

20 : Active

09/30/2022 4552 PLP3, PREC

20 : Clear

4978 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL9/8/2009 (850) 488-0595

Devin Scott Eickelmann

20 : Active

09/30/2022 4677 PLP3, PREC

20 : Clear

4982 Nursing Home Ad

5 : St. Petersburg

Pinellas 521 ATWOOD AVENUE NORTH

FL 33702ST. PETERSBURG

801 [email protected]

PL10/15/2009 (727) 526-7000

Mr Ronald Matthew

Tencza

20 : Active

09/30/2022 4619 PLP3, PREC

20 : Clear

4986 Nursing Home Ad

7 : Orlando

Orange 1730 LUCERNE TERRACE

FL 32806ORLANDO

801 [email protected]

PL11/6/2009 (407) 423-1612

Dean Walter Richardson

20 : Active

09/30/2022 4577 PLP3, PREC

20 : Clear

4992 Nursing Home Ad

10 : Ft. Lauderdale

Broward 1121 NW 115th Avenue

FL 33323PLANTATION

801 [email protected]

PL12/17/2009 954-261-2848

Mrs Chantelle

Kocik

20 : Active

09/30/2022 4706 PLP3, PREC

20 : Clear

4993 Nursing Home Ad

3 : Gainesville

Lake 151 E. MINNEHAHA AVE.

FL 34711CLERMONT

801 [email protected]

PL12/29/2009 352-394-2188

Stacy B. Lingenfelter

20 : Active

09/30/2022 4584 PLP3, PREC

20 : Clear

4999 Nursing Home Ad

5 : St. Petersburg

Pinellas 811 JACKSON ST. NORTH

FL 33705SAINT PETERSBURG

801 [email protected]

PL1/14/2010 727-209-1717

Ms Susan Patricia Dufresne

20 : Active

09/30/2022 4590 PLP3, PREC

20 : Clear

5006 Nursing Home Ad

5 : St. Petersburg

Manatee 5201 Bahia Vista Street

FL 34232SARASOTA

801 [email protected]

PL2/3/2010 315-491-8313

Mrs. Alexandra

Elizabeth

Maliwacki

20 : Active

09/30/2022 4712 PLP3, PREC

20 : Clear

5013 Nursing Home Ad

7 : Orlando

Orange 210 LAKE AVENUE

FL 32801ORLANDO

801 [email protected]

PL3/22/2010 407-872-7088

Ms. Catherine

Marie Henderson

20 : Active

09/30/2022 4616 PLP3, PREC

20 : Clear

5018 Nursing Home Ad

11 : Miami

Miami-Dade

12505 NE. 16TH AVENUE

FL 33161NORTH MIAMI

801 [email protected]

PL4/19/2010 305-891-1710

Ms. Ruth Elizabeth

Robinson

20 : Active

09/30/2022 4648 PLP3, PREC

20 : Clear

5020 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL4/26/2010 (850) 488-0595

Ms. Donna M Wildes

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801 : Nursing Home AdministratorPage 31 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 4751 PLP3, PREC

20 : Clear

5027 Nursing Home Ad

3 : Gainesville

Marion 4100 SW 33RD AVE.

FL 34474OCALA801 [email protected]

PL5/21/2010 352-237-7776

Aaron M. Coppola

20 : Active

09/30/2022 4757 PLP3, PREC

20 : Clear

5035 Nursing Home Ad

8 : Ft. Myers

Lee 13960 PLANTATION RD.

FL 33912FT MYERS

801 [email protected]

PL7/28/2010 239-343-1705

Mrs. Melissa A Shepard

20 : Active

09/30/2022 4615 PLP3, PREC

20 : Clear

5042 Nursing Home Ad

7 : Orlando

Orange 989 ORIENTA AVE

FL 32801ORLANDO

801 [email protected]

PL9/13/2010 407-831-3446

Francisco

Jose Gonzalez

20 : Active

09/30/2022 4664 PLP3, PREC

20 : Clear

5046 Nursing Home Ad

10 : Ft. Lauderdale

Broward 1859 VAN BUREN

FL 33020HOLLYWOOD

801 [email protected]

PL10/25/2010 813-300-8328

Miss Ellisa G Durrant

20 : Active

09/30/2022 4798 PLP3, PREC

20 : Clear

5049 Nursing Home Ad

8 : Ft. Myers

Charlotte 450 Shreve Street

FL 33950PUNTA GORDA

801 [email protected]

PL10/27/2010 (941) 639-8771

Mrs. Kristin Nichole Cardona

20 : Active

09/30/2022 4727 PLP3, PREC

20 : Clear

5070 Nursing Home Ad

7 : Orlando

Orange 1061 Tomyn Blvd

Florida FL 34761OCOEE801 [email protected]

PL11/23/2010 352-222-9999

Mrs Maria Sol Griffin

20 : Active

09/30/2022 4710 PLP3, PREC

20 : Clear

5087 Nursing Home Ad

7 : Orlando

Orange 1091 KELTON AVE

FL 34761OCOEE801 [email protected]

PL12/29/2010 407-523-0300

Adria Mussari

20 : Active

09/30/2022 4713 PLP3, PREC

20 : Clear

5091 Nursing Home Ad

6 : Tampa

Hillsborough

2811 CAMPUS HILL DR.

FL 33612TAMPA801 [email protected]

PL1/12/2011 863-934-7844

Mr. Daniel James Jones

20 : Active

09/30/2022 4814 PLP3, PREC

20 : Clear

5094 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL1/18/2011 (850) 488-0595

Mrs. Ashley Ann Peters

20 : Active

09/30/2022 4760 PLP3, PREC

20 : Clear

5113 Nursing Home Ad

5 : St. Petersburg

Pinellas 6767 86th Avenue N

FL 33782PINELLAS PARK

801 [email protected]

PL3/2/2011 727-258-6600

Ms. Louise Emily Merrick

20 : Active

09/30/2022 4831 PLP3, PREC

20 : Clear

5116 Nursing Home Ad

5 : St. Petersburg

Sarasota 1240 PINEBROOK RD

FL 34285VENICE801 [email protected]

PL3/7/2011 941-488-6733

Dana Agnes Bedford

20 : Active

09/30/2022 4801 PLP3, PREC

20 : Clear

5127 Nursing Home Ad

6 : Tampa

Polk 206 W. ORANGE STREET

FL 33837DAVENPORT

801 [email protected]

PL3/28/2011 321-663-9751

Andy Andre

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801 : Nursing Home AdministratorPage 32 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 4810 PLP3, PREC

20 : Clear

5137 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL4/15/2011 (850) 488-0595

Stephanie

Pena

20 : Active

09/30/2022 4490 PLP3, PREC

20 : Clear

5139 Nursing Home Ad

11 : Miami

Miami-Dade

724 NW 19TH STREET

FL 33128MIAMI801 [email protected]

PL5/4/2011 305-325-2300

Alan Solar

20 : Active

09/30/2022 4745 PLP2, PLP3, PREC

20 : Clear

5141 Nursing Home Ad

2 : Tallahassee

Jackson 2600 FOREST GLEN TRAIL

FL 32446MARIANNA

801 [email protected]

PL5/5/2011 850-526-2000

Mr Brad Howell Nobles

20 : Active

09/30/2022 4741 PLP3, PREC

20 : Clear

5151 Nursing Home Ad

5 : St. Petersburg

Pinellas 1430 PASADENA AVE. S.

FL 33707PASADENA

801 [email protected]

PL5/19/2011 727-344-8525

Nha Sydney Johnson

Rabin

20 : Active

09/30/2022 4789 PLP3, PREC

20 : Clear

5159 Nursing Home Ad

8 : Ft. Myers

Lee 13476 Marquette Blvd

FL 33905FORT MYERS

801 [email protected]

PL6/2/2011 407-999-6018

Dana Elizabeth

Nokley

20 : Active

09/30/2022 4645 PLP3, PREC

20 : Clear

5187 Nursing Home Ad

7 : Orlando

Orange 5201 CURY FORD RD.

FL 32812ORLANDO

801 [email protected]

PL8/10/2011 407-384-8838

Joshua Lee Wagoner

20 : Active

09/30/2022 4806 PLP3, PREC

20 : Clear

5193 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL8/24/2011 (850) 488-0595

Mr. Tyler John Sununu

20 : Active

09/30/2022 4687 PLP3, PREC

20 : Clear

5213 Nursing Home Ad

9 : West Palm Beach

Palm Beach

315 South Flagler Drive

FL 33401WEST PALM BEACH

801 [email protected]

PL10/6/2011 954-865-4029

Louna Pierre Philippe

20 : Active

09/30/2022 4796 PLP3, PREC

20 : Clear

5218 Nursing Home Ad

8 : Ft. Myers

Lee 26455 S. TAMIAMI TRAIL

FL 34134BONITA SPRINGS

801 [email protected]

PL10/21/2011 239-949-7555

Sally Ann Boswell

20 : Active

09/30/2022 4803 PLP3, PREC

20 : Clear

5219 Nursing Home Ad

3 : Gainesville

Suwannee

110 LEE AVE SE.

FL 32064LIVE OAK

801 [email protected]

PL10/21/2011 386-364-5961

Sandra Sue Gant

20 : Active

09/30/2022 4769 PLP3, PREC

20 : Clear

5236 Nursing Home Ad

9 : West Palm Beach

Palm Beach

18944 S E JUPITER RIVER DRIVE

FL 33458JUPITER

801 [email protected]

PL12/2/2011 561-969-1400

Mr Sean Joseph O'Malley

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801 : Nursing Home AdministratorPage 33 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 4843 PLP3, PREC

20 : Clear

5262 Nursing Home Ad

3 : Gainesville

Lake 301 S. BAY STREET

FL 32726EUSTIS801 [email protected]

PL2/10/2012 352-357-8105

Megan Canada Pilko

20 : Active

09/30/2022 4793 PLP3, PREC

20 : Clear

5266 Nursing Home Ad

4 : jacksonville

St.Johns 1003 YORK ROAD

FL 32082PONTE VEDRA BEACH

801 [email protected]

PL2/24/2012 904-285-1055

Mr. Kendall G Bryan Jr

20 : Active

09/30/2022 4823 PLP3, PREC

20 : Clear

5271 Nursing Home Ad

9 : West Palm Beach

Palm Beach

2170 PALM BEACH LAKES BLVD

FL 33409WEST PALM BEACH

801 [email protected]

PL3/13/2012Mr Keslerme

Thelemaque

20 : Active

09/30/2022 4852 PLP3, PREC

20 : Clear

5277 Nursing Home Ad

7 : Orlando

Orange 3211 ROUSE RD.

FL 32817ORLANDO

801 [email protected]

PL3/26/2012 407-281-1070

Mr. Aaron Lee Preston

20 : Active

09/30/2022 4868 PLP3, PREC

20 : Clear

5291 Nursing Home Ad

4 : jacksonville

Volusia 60 N. CHARLES RICHARD BELL BLVD.

FL 32713DEBARY801 [email protected]

PL5/1/2012 386-668-4426

Nha Brian Paul Ouellette

20 : Active

09/30/2022 4872 PLP3, PREC

20 : Clear

5300 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL6/5/2012 (850) 488-0595

Nha Roland Menezil

20 : Active

09/30/2022 4953 PLP3, PREC

20 : Clear

5304 Nursing Home Ad

6 : Tampa

Polk 919 OLD WINTER HAVEN ROAD

FL 33823AUBURNDALE

801 [email protected]

PL6/19/2012 863-947-4125

Katrina L Davis

20 : Active

09/30/2022 4860 PLP3, PREC

20 : Clear

5314 Nursing Home Ad

7 : Orlando

Seminole 710 NORTH SUN DR.

FL 32746LAKE MARY

801 [email protected]

PL7/19/2012 407-805-3131

Lee Roopchand

20 : Active

09/30/2022 4985 PLP3, PREC

20 : Clear

5319 Nursing Home Ad

2 : Tallahassee

Jackson 2136 HWY 73 SOUTH

FL 32448MARIANNA

801 [email protected]

PL8/1/2012 850-547-9289

Mr. Dexter Duane Barber

20 : Active

09/30/2022 4834 PLP3, PREC

20 : Clear

5322 Nursing Home Ad

4 : jacksonville

Duval 1 FLEET LANDING BLVD.

FL 32223JACKSONVILLE

801 [email protected]

PL8/8/2012 904-246-9900

Miss Sacasha

Kionie Brown

20 : Active

09/30/2022 4781 PLP3, PREC

20 : Clear

5342 Nursing Home Ad

11 : Miami

Miami-Dade

19760 SW 101 AVE

FL 33157CUTLER BAY

801 [email protected]

PL8/31/2012 954-577-3535

Charmaine

Erica Bowes-Finegan

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801 : Nursing Home AdministratorPage 34 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 4840 PLP3, PREC

20 : Clear

5343 Nursing Home Ad

6 : Tampa

Pasco 7400 TROUBLE CREEK ROAD

FL 34653NEW PORT RICHEY

801 [email protected]

PL9/4/2012 727-992-1866

Mr Christopher

Michael Sefjack

20 : Active

09/30/2022 4969 PLP3, PREC

20 : Clear

5348 Nursing Home Ad

8 : Ft. Myers

Highlands 725 S. PINE ST

FL 33870SEBRING

801 [email protected]

PL9/17/2012 863-402-4703

Mrs. Chevonne

Elizabeth

Foster

20 : Active

09/30/2022 5012 PLP3, PREC

20 : Clear

5354 Nursing Home Ad

5 : St. Petersburg

Pinellas 10500 STARKEY ROAD

FL 33777LARGO801 [email protected]

PL10/4/2012 727-397-8166

Mrs. Samantha

Gayle Vosloo

20 : Active

09/30/2022 4957 PLP3, PREC

20 : Clear

5356 Nursing Home Ad

4 : jacksonville

Duval 996 ATRIUM WAY

FL 32225JACKSONVILLE

801 [email protected]

PL10/4/2012 907-824-7001

Kyle Jordan Wierzba

20 : Active

09/30/2022 4072 PLP3, PREC

20 : Clear

5359 Nursing Home Ad

9 : West Palm Beach

Palm Beach

5044 Sancerre Circle

FL 33463LAKE WORTH

801 [email protected]

PL10/23/2012 561-436-9356

Mrs. Portia Bryant-Surtain

20 : Active

09/30/2022 4970 PLP3, PREC

20 : Clear

5366 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL11/13/2012 (850) 488-0595

Ms Sandra M Knoble

20 : Active

09/30/2022 4910 PLP3, PREC

20 : Clear

5372 Nursing Home Ad

7 : Orlando

Seminole 1525 HAVEN DRIVE

FL 32765OVIEDO801 [email protected]

PL12/3/2012 407-365-3456

Michael Albert Buxton

20 : Active

09/30/2022 4835 PLP3, PREC

20 : Clear

5381 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL12/28/2012 (850) 488-0595

Mrs. Elsie Francois

Justilien

20 : Active

09/30/2022 4989 PLP3, PREC

20 : Clear

5382 Nursing Home Ad

9 : West Palm Beach

Indian River

1755 37TH ST.

FL 32960VERO BEACH

801 [email protected]

PL12/28/2012 772-567-2443

Mrs Nicole Deann Jordan

20 : Active

09/30/2022 4891 PLP3, PREC

20 : Clear

5383 Nursing Home Ad

5 : St. Petersburg

Pinellas 2655 Nebraska Avenue

FL 34684PALM HARBOR

801 [email protected]

PL1/7/2013 386-451-8485

Richard Randall Rees

20 : Active

09/30/2022 4790 PLP3, PREC

20 : Clear

5388 Nursing Home Ad

11 : Miami

Miami-Dade

6750 WEST 22ND COURT

FL 33016HIALEAH

801 [email protected]

PL1/14/2013 786-587-1377

Mr Jose A Suarez

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 35 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 5035 PLP3, PREC

20 : Clear

5411 Nursing Home Ad

5 : St. Petersburg

Pinellas 1133 STEPHEN FOSTER DR

FL 33771LARGO801 [email protected]

PL3/21/2013 727-269-6533

Mr. Travis Lester Reed

20 : Active

09/30/2022 4731 PLP3, PREC

20 : Clear

5412 Nursing Home Ad

5 : St. Petersburg

Pinellas 401 FAIRWOOD AVENUE

FL 33759CLEARWATER

801 [email protected]

PL3/22/2013 757-210-2600

David Alphonso

Mcmillon

20 : Active

09/30/2022 4927 PLP3, PREC

20 : Clear

5413 Nursing Home Ad

3 : Gainesville

Citrus 124 West Norvell Bryant Highway

FL 34442HERNANDO

801 [email protected]

PL3/22/2013 352-249-3100

Mr. Matthew

Earl Pedersen

20 : Active

09/30/2022 4883 PLP3, PREC

20 : Clear

5425 Nursing Home Ad

7 : Orlando

Brevard 75 CORAL SEA WAY

#8 FL 32937SATELLITE BEACH

801 [email protected]

PL4/19/2013 321-953-2219

Amy R Patrick

20 : Active

09/30/2022 4967 PLP3, PREC

20 : Clear

5435 Nursing Home Ad

6 : Tampa

Pasco 7210 BEACON WOODS DR.

FL 34667HUDSON

801 [email protected]

PL5/29/2013 727-8631521

Mrs Amy Renae Saayman

20 : Active

09/30/2022 5066 PLP3, PREC

20 : Clear

5464 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL7/31/2013 (850) 488-0595

Karole Yvonne Hamilton

20 : Active

09/30/2022 5108 PLP3, PREC

20 : Clear

5481 Nursing Home Ad

8 : Ft. Myers

Collier 16161 CAMDEN LAKES CIR

FL 34110NAPLES801 [email protected]

PL8/28/2013 239-207-5704

Mrs. Diana L. Bailey

20 : Active

09/30/2022 5133 PLP3, PREC

20 : Clear

5487 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL9/25/2013 (850) 488-0595

Mr. Troy Harrison

Churchill

20 : Active

09/30/2022 4934 PLP3, PREC

20 : Clear

5500 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL10/30/2013 (850) 488-0595

Ms Sophia Smith Fyffe

20 : Active

09/30/2022 5111 PLP3, PREC

20 : Clear

5511 Nursing Home Ad

4 : jacksonville

Duval 6209 BROOKS BARTRAM DR

FL 32258JACKSONVILLE

801 [email protected]

PL12/5/2013 904-528-3020

Nha Maria Teresa Interiano

20 : Active

09/30/2022 5119 PLP3, PREC

20 : Clear

5513 Nursing Home Ad

4 : jacksonville

Volusia 170 N. OLD KINGS RD

FL 32174ORMOND BEACH

801 [email protected]

PL12/13/2013 954-774-7007

Jacob Samuel Brush

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801 : Nursing Home AdministratorPage 36 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 4965 PLP3, PREC

20 : Clear

5531 Nursing Home Ad

3 : Gainesville

Lake 630 Griffin Ave

FL 32159LADY LAKE

801 [email protected]

PL1/30/2014 352-750-6619

Mrs. Brandy Renee Felicita

20 : Active

09/30/2022 5045 PLP3, PREC

20 : Clear

5549 Nursing Home Ad

2 : Tallahassee

Leon 1609 MEDICAL DRIVE

FL 32308TALLAHASSEE

801 [email protected]

PL3/20/2014 850-431-2911

Admi Norman Terrell Pasley

20 : Active

09/30/2022 5054 PLP3, PREC

20 : Clear

5550 Nursing Home Ad

7 : Orlando

Seminole 155 LANDOVER PLACE

FL 32750LONGWOOD

801 [email protected]

PL3/20/2014 407-830-7744

Stephanie

Marie Norsen

20 : Active

09/30/2022 5039 PLP3, PREC

20 : Clear

5552 Nursing Home Ad

7 : Orlando

Brevard 2279 MAEVE CIRCLE

FL 32904MELBOURNE

801 [email protected]

PL3/20/2014 772-567-7400

Mrs. Erelyn J Hicks

20 : Active

09/30/2022 5086 PLP3, PREC

20 : Clear

5553 Nursing Home Ad

7 : Orlando

Orange 5900 Lake Ellenor Dr

FL 32809ORLANDO

801 [email protected]

PL3/21/2014Mr Brian Jay Smith

20 : Active

09/30/2022 5177 PLP3, PREC

20 : Clear

5557 Nursing Home Ad

7 : Orlando

Seminole 1024 Willa Springs Drive

FL 32708WINTER SPRINGS

801 [email protected]

PL4/1/2014 925-639-8332

Rachael Joy Mazer

20 : Active

09/30/2022 5190 PLP3, PREC

20 : Clear

5566 Nursing Home Ad

2 : Tallahassee

Bay 626 N. Tyndall Parkway

FL 32404PANAMA CITY

801 [email protected]

PL4/18/2014 850-871-6363

Vicki Lynn Brown

20 : Active

09/30/2022 5138 PLP3, PREC

20 : Clear

5568 Nursing Home Ad

9 : West Palm Beach

Palm Beach

16200 JOG ROAD

FL 33446DELRAY BEACH

801 [email protected]

PL4/22/2014 561-638-0000

Mr. Gregory Raymond

Leoce

20 : Active

09/30/2022 5189 PLP3, PREC

20 : Clear

5570 Nursing Home Ad

0 : None Out Of State

490 Pelham Rd

NY 10805NEW ROCHELLE

801 [email protected]

PL4/22/2014 914-514-2800

Mr Jose Luis Rojas Fernandez

20 : Active

09/30/2022 5172 PLP3, PREC

20 : Clear

5579 Nursing Home Ad

9 : West Palm Beach

Palm Beach

3600 MASTERPIECE WAY

FL 33410PALM BEACH GARDENS

801 [email protected]

PL6/12/2014 561-514-5000

Lnha Marty Hopek

20 : Active

09/30/2022 4971 PLP3, PREC

20 : Clear

5594 Nursing Home Ad

11 : Miami

Miami-Dade

1404 NW. 22ND STREET

FL 33142MIAMI801 [email protected]

PL6/13/2014 305-325-1050

Mr. Alexis I Morfa

20 : Active

09/30/2022 5165 PLP3, PREC

20 : Clear

5599 Nursing Home Ad

8 : Ft. Myers

Lee 13960 PLANTATION ROAD

FL 33912FORT MYERS

801 [email protected]

PL6/27/2014 231-343-1705

Laura Ann Noble

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801 : Nursing Home AdministratorPage 37 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 5127 PLP3, PREC

20 : Clear

5610 Nursing Home Ad

3 : Gainesville

Sumter 16529 S.E. 86TH BELLE MEADE CIRCLE

FL 32162THE VILLAGES

801 [email protected]

PL7/15/2014 352-385-8200

Mr. Daniel George Cleaver

20 : Active

09/30/2022 5088 PLP3, PREC

20 : Clear

5611 Nursing Home Ad

1 : Pensacola

Santa Rosa

1537 Sabal Palm Dr

FL 32563GULF BREEZE

801 [email protected]

PL7/15/2014 850-932-9257

Mr. Justin Kiel Gibson

20 : Active

09/30/2022 5089 PLP3, PREC

20 : Clear

5628 Nursing Home Ad

7 : Orlando

Orange 250 S. CHICKASAW TRAIL

FL 32825ORLANDO

801 [email protected]

PL8/26/2014 352-409-3617

Jeffrey Carl Lind

20 : Active

09/30/2022 5176 PLP3, PREC

20 : Clear

5639 Nursing Home Ad

1 : Pensacola

Escambia 8475 UNIVERSITY PARKWAY

FL 32514PENSACOLA

801 [email protected]

PL8/28/2014 850-474-1252

Mr Randall James Mcclellan

20 : Active

09/30/2022 5082 PLP3, PREC

20 : Clear

5641 Nursing Home Ad

5 : St. Petersburg

Pinellas 464 KLOSTERMAN RD W

FL 34683PALM HARBOR

801 [email protected]

PL9/4/2014 727-787-1500

Lisa M Kolman

20 : Active

09/30/2022 5123 PLP3, PREC

20 : Clear

5643 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL9/15/2014 (850) 488-0595

Mr. Bret Austin Martin

20 : Active

09/30/2022 5235 NAB, PLP3, PREC

20 : Clear

5654 Nursing Home Ad

3 : Gainesville

Marion 991 SE 67th Ct.

FL 34472OCALA801 [email protected]

PL10/13/2014 321-288-3025

Joseph Richard Wanczyk

20 : Active

09/30/2022 5219 PLP3, PREC

20 : Clear

5674 Nursing Home Ad

7 : Orlando

Orange 1620 MAYFLOWER COURT

FL 32792WINTER PARK

801 [email protected]

PL11/3/2014 407-672-1620

Nha Ben Paul Anderson

20 : Active

09/30/2022 5072 PLP3, PREC

20 : Clear

5676 Nursing Home Ad

3 : Gainesville

Suwannee

1620 SE HELVENSTON STREET

FL 32064LIVE OAK

801 [email protected]

PL11/21/2014 386-362-7860

Ms. Raven Symone Jackson

20 : Active

09/30/2022 5243 PLP3, PREC

20 : Clear

5680 Nursing Home Ad

7 : Orlando

Osceola 4201 NOLTE RD

FL 34772SAINT CLOUD

801 [email protected]

PL12/5/2014 407-957-3341

Charlene

Joy Bedor

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 38 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 5267 PLP3, PREC

20 : Clear

5713 Nursing Home Ad

5 : St. Petersburg

Manatee 1533 4th Ave West

FL 34205BRADENTON

801 [email protected]

PL2/25/2015Mrs. Tracey Lynn Rickabaugh

20 : Active

09/30/2022 5301 PLP3, PREC

20 : Clear

5727 Nursing Home Ad

6 : Tampa

Polk 206 W. Orange St

FL 33837DAVENPORT

801 [email protected]

PL3/27/2015 863-422-4961

Michael James Desmond

20 : Active

09/30/2022 5250 PLP3, PREC

20 : Clear

5729 Nursing Home Ad

0 : None Out Of State

223 ABERDEEN CT.

MI 48111BELLEVILLE

801 [email protected]

PL4/7/2015Mr. Robert V. Boyd

20 : Active

09/30/2022 5214 PLP3, PREC

20 : Clear

5754 Nursing Home Ad

6 : Tampa

Hillsborough

37300 ROYAL OAK WAY

FL 33625DADE CITY

801 [email protected]

PL6/2/2015 352-567-3122

Jacob Daryl Rolfe

Mitchell

20 : Active

09/30/2022 5274 PLP3, PREC

20 : Clear

5755 Nursing Home Ad

3 : Gainesville

Marion 1201 SE 24th Road

FL 34471OCALA801 [email protected]

PL6/2/2015 850-933-7866

Tyler Fields Price

20 : Active

09/30/2022 5304 PLP3, PREC

20 : Clear

5784 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL6/11/2015 (850) 488-0595

Mr. James Chandler

Ransone

20 : Active

09/30/2022 5300 PLP3, PREC

20 : Clear

5792 Nursing Home Ad

9 : West Palm Beach

Palm Beach

10330 NUVISTA AVENUE

FL 33414WELLINGTON

801 [email protected]

PL7/1/2015 561-598-5407

Ms. Sarah Rose Ostrow

20 : Active

09/30/2022 5069 PLP3, PREC

20 : Clear

5805 Nursing Home Ad

10 : Ft. Lauderdale

Broward 6931 W Sunrise Blvd

FL FL 33313PLANTATION

801 [email protected]

PL7/20/2015 954-583-6200

Lnha Rita Diana Hollingsworth

Mrs

20 : Active

09/30/2022 5364 PLP3, PREC

20 : Clear

5829 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL10/16/2015 (850) 488-0595

Vanessa

Sylverain

20 : Active

09/30/2022 5266 PLP3, PREC

20 : Clear

5842 Nursing Home Ad

1 : Pensacola

Escambia 3107 N H St

FL 32501PENSACOLA

801 [email protected]

PL10/29/2015 850-430-0500

Mr Joseph Gene Randolph

20 : Active

09/30/2022 5317 PLP3, PREC

20 : Clear

5884 Nursing Home Ad

9 : West Palm Beach

St.Lucie 2011 SW Janette Avenue

FL 34953PORT SAINT LUCIE

801 [email protected]

PL2/19/2016 786-897-2262

Jerry Remedor

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MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 39 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 5256 PLP3, PREC

20 : Clear

5887 Nursing Home Ad

4 : jacksonville

Volusia 1219 N. RIDGEWOOD AVE

FL 32720DELAND801 [email protected]

PL2/19/2016 407-628-5418

Timothy Vincent Leonard

20 : Active

09/30/2022 5283 PLP3, PREC

20 : Clear

5897 Nursing Home Ad

6 : Tampa

Pasco 3830 Gainer Springs Avenue

FL 34653NEW PORT RICHEY

801 [email protected]

PL3/17/2016 727-267-1576

Nicole Desiree Francis

20 : Active

09/30/2022 5443 L&R, PLP3, PREC

20 : Clear

5925 Nursing Home Ad

6 : Tampa

Pasco 38220 HENRY DR.

FL 33542ZEPHYRHILLS

801 [email protected]

PL5/25/2016 813-788-7114

Patti Jo Robinson

20 : Active

09/30/2022 5492 L&R, NAB, PLP3, PREC

20 : Clear

5944 Nursing Home Ad

4 : jacksonville

Clay 1280 HENIEY RD.

FL 32068MIDDLEBURG

801 [email protected]

PL7/22/2016 352-231-9174

Erica Lynn Henderson

20 : Active

09/30/2022 5464 L&R, NAB, PLP3, PREC

20 : Clear

5945 Nursing Home Ad

5 : St. Petersburg

Manatee 926 HABEN BLVD.

FL 34221PALMETTO

801 [email protected]

PL7/27/2016 941-722-0553

Mr. Woodie Wallace Lee Jr

20 : Active

09/30/2022 5445 L&R, NAB, PLP3, PREC

20 : Clear

5947 Nursing Home Ad

6 : Tampa

Hillsborough

3030 WEST BEARSS AVE.

FL 33618TAMPA801 [email protected]

PL7/27/2016Alexandra

Estefania

Quay

20 : Active

09/30/2022 5451 L&R, PLP3, PREC

20 : Clear

5960 Nursing Home Ad

4 : jacksonville

St.Johns 273 Oxford Estates Way

FL 32259SAINT JOHNS

801 [email protected]

PL8/18/2016 904-739-0877

Shonda Monique

Taylor

20 : Active

09/30/2022 5506 L&R, NAB, PLP3, PREC

20 : Clear

5976 Nursing Home Ad

7 : Orlando

Brevard 1420 S OAK ST.

FL 32901MELBOURNE

801 [email protected]

PL9/29/2016 321-723-3215

Mrs. Jody M Spinneweber

20 : Active

09/30/2022 5495 L&R, PLP3, PREC

20 : Clear

5977 Nursing Home Ad

10 : Ft. Lauderdale

Broward 777 South Douglas Road

FL 33025PEMBROKE PINES

801 [email protected]

PL9/29/2016 954-276-6201

Jon Hennemyre

20 : Active

09/30/2022 5473 L&R, PLP3, PREC

20 : Clear

5980 Nursing Home Ad

8 : Ft. Myers

Charlotte 23013 WESTCHESTER BLVD.

FL 33980PORT CHARLOTTE

801 [email protected]

PL10/12/2016 941-625-1220

Tamarah

Ann Dicus Wilbert

pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health

Page 40: MQA Reports License Master List for Addresses 801 ...floridasnursinghomeadmin.gov/forms/preceptor_list_AIT.pdfFile Nbr Lic Nbr Rank Lic Region County Status Expr Dte Date Sec Sta Ad

MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 40 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 5483 L&R, PLP3, PREC, TEMP

20 : Clear

5984 Nursing Home Ad

8 : Ft. Myers

Lee 17380 Kentara Way

FL 33913FORT MYERS

801 [email protected]

PL10/13/2016Rachel M Zellers

20 : Active

09/30/2022 5521 L&R, PLP3, PREC

20 : Clear

5993 Nursing Home Ad

6 : Tampa

Polk 1350 SLEEPY HILL RD.

FL 33810LAKELAND

801 [email protected]

PL11/9/2016 863-858-4402

Rebecca

Kathlene

Colon

20 : Active

09/30/2022 5510 1000, NBFL, PLP3, PREC

20 : Clear

6041 Nursing Home Ad

1 : Pensacola

Okaloosa 1849 FIRST AVE. EAST

FL 32539CRESTVIEW

801 [email protected]

PL3/30/2017 850-682-5322

Mr. Daniel Patrick Blakely

20 : Active

09/30/2022 5528 L&R, PLP3, PREC, TEMP

20 : Clear

6047 Nursing Home Ad

9 : West Palm Beach

Palm Beach

9600 LAWRENCE RD.

FL 33436BOYNTON BEACH

801 [email protected]

PL4/17/2017 561-740-4100

Mrs Terri Nichole Anno

20 : Active

09/30/2022 5346 NBFL, PLP3, PREC

20 : Clear

6052 Nursing Home Ad

8 : Ft. Myers

Lee 10500 CYPRESS COVE DR.

FL 33908FORT MYERS

801 [email protected]

PL4/20/2017 239-415-5100

Matthew

Brooks Lessig

20 : Active

09/30/2022 5638 NBFL, PLP3, PREC

20 : Clear

6069 Nursing Home Ad

11 : Miami

Miami-Dade

1255 NE 135 ST.

FL 33161NORTH MIAMI

801 [email protected]

PL6/7/2017 305-891-6850

Mr. Mauricio

Abello Jr.

20 : Active

09/30/2022 5620 L&R, PLP3, PREC, TEMP

20 : Clear

6097 Nursing Home Ad

NOT PRACTICING

801 [email protected]

PL7/19/2017 (850) 488-0595

Michael A Mahan

20 : Active

09/30/2022 5582 NAB, NBFL, PLP3, PREC

20 : Clear

6113 Nursing Home Ad

6 : Tampa

Hillsborough

1619 STORINGTON AVENUE

FL 33511BRANDON

801 [email protected]

PL8/17/2017Mariela Martinez

20 : Active

09/30/2022 5610 L&R, PLP3, PREC, TEMP

20 : Clear

6138 Nursing Home Ad

0 : None Out Of State

2852 McDermo 2852 McDermott Pond Creek Road

OH 45652MCDERMOTT

801 [email protected]

PL10/26/2017 740-981-2020

Mr William Scott Marshall

pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health

Page 41: MQA Reports License Master List for Addresses 801 ...floridasnursinghomeadmin.gov/forms/preceptor_list_AIT.pdfFile Nbr Lic Nbr Rank Lic Region County Status Expr Dte Date Sec Sta Ad

MQA ReportsLicense Master List for Addresses

801 : Nursing Home AdministratorPage 41 of 41

Expiry DateSort Order:

Rank

License Number

Processed: 5/4/2021 7:46:43AM Status=20 Sec Status = 20 Rank = ALL Modifier = PREC Zip = ALL Region = ALL County = ALLAddr = PL

File Nbr CountyRegionRankLic Nbr LicStatus

Expr DteDate

Sec Sta

Ad Line 1

Ad Line 2

Ad Line 3

AdSt

AdZip

AdCity

Clnt EmailTyOrig Iss Mod PhoneNmeTitle

NmeFirst

NmeMid

NmeLast

NSfx

20 : Active

09/30/2022 5592 L&R, PLP3, PREC

20 : Clear

6160 Nursing Home Ad

9 : West Palm Beach

Palm Beach

375 N.W. 51ST STREET

FL 33431BOCA RATON

801 'kansas' <[email protected]>

PL1/9/2018 561-997-8111

Antonio A Thomas

20 : Active

09/30/2022 5781 L&R, PLP3, PREC

20 : Clear

6190 Nursing Home Ad

9 : West Palm Beach

Palm Beach

198 EAST TALL OAKS CIRCLE

FL 33410PALM BEACH GARDENS

801 [email protected]

PL3/12/2018 561-478-1800

Jennifer Ann Baron

20 : Active

09/30/2022 5685 1000, NBFL, PLP3, PREC

20 : Clear

6208 Nursing Home Ad

3 : Gainesville

Gilchrist 7280 SW SR 26

FL 32693TRENTON

801 [email protected]

PL4/19/2018 352-463-1222

Ms. Heather Snellgrove

20 : Active

09/30/2022 5877 L&R, MSSN, PLP3, PREC

20 : Clear

6302 Nursing Home Ad

9 : West Palm Beach

Indian River

1310 37th STREET

FL 32960VERO BEACH

801 [email protected]

PL10/23/2018 772-569-5107

Ms. Gladys Christopher

20 : Active

09/30/2022 5838 L&R, PLP3, PREC, TEMP

20 : Clear

6377 Nursing Home Ad

8 : Ft. Myers

Lee 28991 SETON CRT

FL 34134BONITA SPRINGS

801 [email protected]

PL4/11/2019 239-775-7715

Mr Duane Christopher

Smith

License Count: 437

pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health