NameCYNTHIA GALE ROLLER
City/State

License and Registration Information
CredentialLicense TypeOriginal IssueIssue DateExpiration DateStatusDisciplineHow issuedDescription
COA.00216-NM Certified Nurse MidWife 06/27/1997 06/21/2013 08/31/2015 LAPSED
COA.09912-NP Certified Nurse Practitioner 02/07/2008 07/06/2015 08/31/2017 ACTIVE
CTP.00216- Prescriptive Authority 02/20/2008 06/21/2013 08/31/2015 LAPSED
CTP.00216-EX1 Prescriptive Authority - Externship 02/20/2008 02/20/2008 02/20/2009 INACTIVE
CTP.00216-EX2 Prescriptive Authority - Externship Extension 02/20/2008 10/28/2009 02/20/2010 INACTIVE
RN.197199-2 Registered Nurse-2 Certificates of Authority 09/12/1985 07/02/2015 08/31/2017 ACTIVE Examination
License and Registration Information (cont.)
CredentialSpecialty 1Certifying Org 1Certifying ExpDate 1Specialty 2Certifying Org 2Certifying ExpDate 2Specialty 3Certifying Org 3Certifying ExpDate 3
COA.00216-NMAMCB12/31/2012
Effective February 1, 2011, the Board will require primary source verification for advanced practice nurse national recertification. For this to occur, an advanced practice nurse must request that their national certifying organization notify the Board directly of national recertification within thirty days of their recertification. The Board will no longer accept documentation of recertification directly from a COA holder.
COA.09912-NPNP - WOMEN'S HEALTHNCC12/31/2011
Effective February 1, 2011, the Board will require primary source verification for advanced practice nurse national recertification. For this to occur, an advanced practice nurse must request that their national certifying organization notify the Board directly of national recertification within thirty days of their recertification. The Board will no longer accept documentation of recertification directly from a COA holder.

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