TIFFANY A LAKE LUCKETT Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****47

License Status

ACTIVE

Business

First Name

TIFFANY

Middle

Last Name

LAKE LUCKETT

Prefix

Business Name

TIFFANY A LAKE LUCKETT

Original Issue Date

11/10/2022

Effective Date

03/07/2024

Expiration Date

05/31/2026

City

WARRENVILLE

State

Zip

60563

County

DUPAGE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026