SALLY A TAMIZUDDIN Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****92

License Status

INACTIVE

Business

First Name

SALLY

Middle

Last Name

TAMIZUDDIN

Business Name

SALLY A TAMIZUDDIN

Original Issue Date

07/14/2022

Effective Date

03/05/2024

Expiration Date

05/31/2026

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/21/2025