CLAUDETTE FAE JACKSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002210

License Status

NOT RENEWED

Business

First Name

CLAUDETTE

Middle

FAE

Last Name

JACKSON

Business Name

CLAUDETTE FAE JACKSON

Original Issue Date

02/13/2004

Effective Date

02/13/2004

Expiration Date

03/01/2008

City

FORT MYERS

State

Zip

33907

Ever Disciplined

LastModifiedDate

08/16/2017