TINA RENEE ENTWISTLE DPM Podiatrist License verification

Business Entity

ACTIVE

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****13

License Status

ACTIVE

Business

First Name

TINA

Middle

RENEE

Last Name

ENTWISTLE

Suffix

DPM

Business Name

TINA RENEE ENTWISTLE DPM

Original Issue Date

03/08/2023

Effective Date

01/29/2025

Expiration Date

01/31/2027

City

ROSCOE

State

Zip

61073

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/29/2025