WALLACE ADAM GOFORTH Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADVANCED PRACTICE REGISTERED NURSE

License Number

209016165

License Status

NOT RENEWED

Business

First Name

WALLACE

Middle

ADAM

Last Name

GOFORTH

Business Name

WALLACE ADAM GOFORTH

Original Issue Date

07/12/2017

Effective Date

04/26/2018

Expiration Date

09/30/2020

City

CARBONDALE

State

Zip

62901

County

FLORIDA

Ever Disciplined

LastModifiedDate

01/14/2021