TIFFANY RAE HENDRICKSON Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****58

License Status

ACTIVE

Business

First Name

TIFFANY

Middle

RAE

Last Name

HENDRICKSON

Business Name

TIFFANY RAE HENDRICKSON

Original Issue Date

06/14/2024

Effective Date

06/14/2024

Expiration Date

05/31/2026

City

PARK CITY

State

Zip

60085

County

LAKE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026