JENNIFER LEA WALLACE Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002421

License Status

INACTIVE

Business

First Name

JENNIFER

Middle

LEA

Last Name

WALLACE

Business Name

JENNIFER LEA WALLACE

Original Issue Date

12/02/2004

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

SARASOTA

State

Zip

34232

County

FLORIDA

Ever Disciplined

LastModifiedDate

12/09/2009