License and Registration Information
CredentialLicense TypeOriginal IssueIssue DateExpiration DateStatusDisciplineHow issuedDescription
COA.12325-NP Certified Nurse Practitioner 05/02/2011 05/02/2011 08/31/2013 LAPSED
CTP.12325-EX1 Prescriptive Authority - Externship 05/02/2011 05/02/2011 05/02/2012 LAPSED
IR.947555-ENDS Registered Nurse - Temporary Work Permit 08/31/2008 08/31/2008 02/28/2009 CLOSED License Issued
RN.345695- Registered Nurse 10/09/2008 05/21/2012 08/31/2013 LAPSED Endorsement
License and Registration Information (cont.)
CredentialSpecialty 1Certifying Org 1Certifying ExpDate 1Specialty 2Certifying Org 2Certifying ExpDate 2Specialty 3Certifying Org 3Certifying ExpDate 3
COA.12325-NPNP - FAMILYANCC3/7/2016
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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