NICOLE M JACK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006579

License Status

ACTIVE

Business

First Name

NICOLE

Middle

Last Name

JACK

Business Name

NICOLE M JACK

Original Issue Date

05/02/2018

Effective Date

02/17/2026

Expiration Date

03/01/2028

City

CHATHAM

State

Zip

62629

County

SANGAMON

Ever Disciplined

LastModifiedDate

02/17/2026