TAYLOR RAE PARK Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****64

License Status

ACTIVE

Business

First Name

TAYLOR

Middle

RAE

Last Name

PARK

Business Name

TAYLOR RAE PARK

Original Issue Date

09/13/2024

Effective Date

09/13/2024

Expiration Date

05/31/2026

City

JERSEYVILLE

State

Zip

62052

County

JERSEY

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026