License and Registration Information
CredentialLicense TypeOriginal IssueIssue DateExpiration DateStatusDisciplineHow issuedDescription
COA.11074-NP Certified Nurse Practitioner 10/01/2009 06/30/2015 08/31/2017 ACTIVE
CTP.11074- Prescriptive Authority 01/27/2011 06/30/2015 08/31/2017 ACTIVE
CTP.11074-EX2 Prescriptive Authority - Externship Extension 10/06/2010 01/27/2011 10/06/2011 CLOSED
CTP.11074-EX1 Prescriptive Authority - Externship 10/06/2009 10/06/2009 10/06/2010 CLOSED
RN.315859-1 Registered Nurse-1 Certificate of Authority 01/26/2005 06/30/2015 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.11074-NPNP - ADULTANCC9/15/2019
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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