TIFFANI A BOTTS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****27

License Status

NOT RENEWED

Business

First Name

TIFFANI

Middle

Last Name

BOTTS

Business Name

TIFFANI A BOTTS

Original Issue Date

07/21/2015

Effective Date

02/05/2016

Expiration Date

03/01/2018

City

VILLA PARK

State

Zip

60181

County

DUPAGE

Ever Disciplined

LastModifiedDate

05/10/2018