TRACY I JACKSON Advanced Practice Nurse License verification

Business Entity

NOT RENEWED

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****06

License Status

NOT RENEWED

Business

First Name

TRACY

Middle

Last Name

JACKSON

Business Name

TRACY I JACKSON

Original Issue Date

03/06/2017

Effective Date

03/01/2018

Expiration Date

09/30/2020

City

WAUKEGAN

State

Zip

60085

County

LAKE

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/14/2021