License and Registration Information
CredentialLicense TypeOriginal IssueIssue DateExpiration DateStatusDisciplineHow issuedDescription
COA.10006-NP Certified Nurse Practitioner 04/10/2008 08/26/2009 08/31/2011 LAPSED
CTP.10006-EX1 Prescriptive Authority - Externship 04/22/2008 04/22/2008 04/22/2009 INACTIVE
RN.299756-1 Registered Nurse-1 Certificate of Authority 02/14/2002 04/10/2008 08/31/2009 LAPSED Examination
License and Registration Information (cont.)
CredentialSpecialty 1Certifying Org 1Certifying ExpDate 1Specialty 2Certifying Org 2Certifying ExpDate 2Specialty 3Certifying Org 3Certifying ExpDate 3
COA.10006-NPNP - ACUTE CAREANCC2/26/2013
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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