TAVIA N SMITH Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****10

License Status

ACTIVE

Business

First Name

TAVIA

Middle

Last Name

SMITH

Business Name

TAVIA N SMITH

Original Issue Date

05/26/2022

Effective Date

03/03/2026

Expiration Date

05/31/2028

City

GRANITE CITY

State

Zip

62040

County

MADISON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/03/2026