TARA COLE NIKODEM Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****28

License Status

ACTIVE

Business

First Name

TARA

Middle

COLE

Last Name

NIKODEM

Business Name

TARA COLE NIKODEM

Original Issue Date

03/01/2013

Effective Date

01/20/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60607

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/20/2026