ANDREA MARIE BLACK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004270

License Status

ACTIVE

Business

First Name

ANDREA

Middle

MARIE

Last Name

BLACK

Business Name

ANDREA MARIE BLACK

Original Issue Date

01/18/2012

Effective Date

02/09/2026

Expiration Date

03/01/2028

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

02/09/2026