CYNTHIA A JACK Advanced Practice Nurse License verification

Business Entity

INOPERATIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****66

License Status

INOPERATIVE

Business

First Name

CYNTHIA A

Last Name

JACK

Business Name

CYNTHIA A JACK

Original Issue Date

01/07/2013

Effective Date

03/02/2026

Expiration Date

05/31/2028

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026