TRACY C FULLER Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****80

License Status

ACTIVE

Business

First Name

TRACY

Middle

Last Name

FULLER

Business Name

TRACY C FULLER

Original Issue Date

09/11/2012

Effective Date

01/22/2026

Expiration Date

03/01/2028

City

MOUNT PROSPECT

State

Zip

60056

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/22/2026