License and Registration Information
CredentialLicense TypeOriginal IssueIssue DateExpiration DateStatusDisciplineHow issuedDescription
COA.12300-NP Certified Nurse Practitioner 04/08/2011 06/18/2015 08/31/2017 ACTIVE
CTP.12300-EX1 Prescriptive Authority - Externship 05/05/2011 09/29/2011 05/05/2012 CLOSED
CTP.12300- Prescriptive Authority 05/05/2011 06/18/2015 08/31/2017 ACTIVE
Registered Nurse - Temporary Work Permit CLOSED License Issued
RN.333897-1 Registered Nurse-1 Certificate of Authority 07/02/2007 06/18/2015 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.12300-NPNP - ADULTAANP2/28/2021
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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