JENNIFER K BLACK Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****00

License Status

ACTIVE

Business

First Name

JENNIFER K

Last Name

BLACK

Business Name

JENNIFER K BLACK

Original Issue Date

07/25/2001

Effective Date

05/12/2024

Expiration Date

05/31/2026

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026