License and Registration Information
CredentialLicense TypeOriginal IssueIssue DateExpiration DateStatusDisciplineHow issuedDescription
COA.11053-NP Certified Nurse Practitioner 09/23/2009 07/02/2015 08/31/2017 ACTIVE
CTP.11053- Prescriptive Authority 09/16/2010 07/02/2015 08/31/2017 ACTIVE
CTP.11053-EX1 Prescriptive Authority - Externship 11/04/2009 09/16/2010 11/04/2010 CLOSED
RN.283391-1 Registered Nurse-1 Certificate of Authority 03/11/1999 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.11053-NPNP - Pediatric Primary CarePNCB2/28/2016
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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