TIMOTHY JOHN CRISCUOLO Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****60

License Status

NOT RENEWED

Business

First Name

TIMOTHY

Middle

JOHN

Last Name

CRISCUOLO

Business Name

TIMOTHY JOHN CRISCUOLO

Original Issue Date

09/04/2018

Effective Date

09/04/2018

Expiration Date

03/01/2020

City

HARVEY

State

Zip

60426

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020