TARA TABBAA Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****16

License Status

NOT RENEWED

Business

First Name

TARA

Last Name

TABBAA

Business Name

TARA TABBAA

Original Issue Date

12/17/2020

Effective Date

12/17/2020

Expiration Date

03/01/2022

City

MELROSE PARK

State

Zip

60160

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022