Page 1
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 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 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 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 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 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
pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health
Page 7
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
pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health
Page 8
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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Page 9
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
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Page 10
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
pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health
Page 11
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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Page 12
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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Page 13
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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Page 14
MQA ReportsLicense Master List for Addresses
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
pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health
Page 15
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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Page 16
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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Page 17
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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Page 18
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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Page 19
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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Page 20
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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Page 21
MQA ReportsLicense Master List for Addresses
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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Page 22
MQA ReportsLicense Master List for Addresses
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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Page 23
MQA ReportsLicense Master List for Addresses
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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Page 24
MQA ReportsLicense Master List for Addresses
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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Page 25
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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Page 26
MQA ReportsLicense Master List for Addresses
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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Page 27
MQA ReportsLicense Master List for Addresses
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
pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health
Page 28
MQA ReportsLicense Master List for Addresses
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
pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health
Page 29
MQA ReportsLicense Master List for Addresses
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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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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MQA ReportsLicense Master List for Addresses
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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Page 35
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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
pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health
Page 36
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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
pkg_rpt_appl.p_dxl532a:05/04/2021 07:46:43 VR-- FOR INTERNAL USE ONLY --Florida Department of Health
Page 37
MQA ReportsLicense Master List for Addresses
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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Page 38
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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Page 39
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
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Page 40
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 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