License and Registration Information
CredentialLicense TypeOriginal IssueIssue DateExpiration DateStatusDisciplineHow issuedDescription
COA.13182-NP Certified Nurse Practitioner 02/28/2012 06/22/2015 08/31/2017 ACTIVE
CTP.13182-EX1 Prescriptive Authority - Externship 08/15/2012 08/15/2012 08/15/2013 EXPIRED
RN.287769-1 Registered Nurse-1 Certificate of Authority 11/03/1999 06/22/2015 08/31/2017 ACTIVE Endorsement
License and Registration Information (cont.)
CredentialSpecialty 1Certifying Org 1Certifying ExpDate 1Specialty 2Certifying Org 2Certifying ExpDate 2Specialty 3Certifying Org 3Certifying ExpDate 3
COA.13182-NPNP - ACUTE CAREANCC3/31/2013
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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