TARA R TRENT Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****80

License Status

INOPERATIVE

Business

First Name

TARA

Middle

Last Name

TRENT

Business Name

TARA R TRENT

Original Issue Date

11/22/2013

Effective Date

02/25/2016

Expiration Date

03/01/2018

City

SPRINGFIELD

State

Zip

62781

County

SANGAMON

Ever Disciplined

LastModifiedDate

05/02/2018