TRACI L BLAKE Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****48

License Status

ACTIVE

Business

First Name

TRACI

Middle

Last Name

BLAKE

Business Name

TRACI L BLAKE

Original Issue Date

07/23/2025

Effective Date

07/23/2025

Expiration Date

05/31/2026

City

ROCKFORD

State

Zip

61114

County

BOONE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026