TRACEE ANGELA BLACKBURN Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****16

License Status

ACTIVE

Business

First Name

TRACEE

Middle

ANGELA

Last Name

BLACKBURN

Business Name

TRACEE ANGELA BLACKBURN

Original Issue Date

10/21/2005

Effective Date

02/17/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60657

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/17/2026