NICOLE M JACK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****00

License Status

ACTIVE

Business

First Name

NICOLE

Middle

Last Name

JACK

Business Name

NICOLE M JACK

Original Issue Date

07/17/2018

Effective Date

03/01/2026

Expiration Date

03/01/2028

City

JACKSONVILLE

State

Zip

62650

County

MORGAN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/01/2026