STACY DEL CARMEN MEDINA Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****62

License Status

ACTIVE

Business

First Name

STACY

Middle

DEL CARMEN

Last Name

MEDINA

Business Name

STACY DEL CARMEN MEDINA

Original Issue Date

08/24/2023

Effective Date

02/07/2024

Expiration Date

03/01/2026

City

SPRINGFIELD

State

Zip

62711

County

SANGAMON

Ever Disciplined

LastModifiedDate

12/03/2025