PAUL ALLEN KLOCKENGA Nursing Home Administrator License verification

Business Entity

INACTIVE

License Type

Nursing Home Administrator

Description

LICENSED NURSING HOME ADMINISTRATOR

License Number

044001461

License Status

INACTIVE

Business

First Name

PAUL ALLEN

Last Name

KLOCKENGA

Business Name

PAUL ALLEN KLOCKENGA

Original Issue Date

07/20/1976

Expiration Date

11/30/1999

City

DAYTONA BEACH

State

Zip

32119

County

FLORIDA

Ever Disciplined

LastModifiedDate

10/11/2005

Case Number

1996004783

Action

Probation

Discipline Start Date

09/30/1996

Discipline End Date

09/29/1997

Discipline Reason

Failed to submit sufficient proof of continuing education hours during a Department audit.