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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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E
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ELEVENTH
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18
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4100 – Safe Body Art
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PR0548222
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COMPLIANCE INFO
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Entry Properties
Last modified
2/9/2026 1:09:56 PM
Creation date
4/16/2024 4:19:45 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0548222
PE
4110 - BODY ART PRACTITIONER REGISTRATION
FACILITY_ID
FA0027512
FACILITY_NAME
IN BLOOM TATTOO (PATRON, YANELI)
STREET_NUMBER
18
Direction
E
STREET_NAME
ELEVENTH
STREET_TYPE
ST
City
TRACY
Zip
95376
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
Site Address
18 E ELEVENTH ST TRACY 95376
Tags
EHD - Public
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CERTIFICATE OF COMPLETION <br /> LICENSEE INFORMATION <br /> First Name:Yaneh <br /> Last Name: Patron <br /> License #: N/A 1910.1030 DOB: <br /> Licensee Si nature: Date:01/26/2023 <br /> CERTIFICATION BY INSTRUCTOR <br /> Course Title:OSHA Compliant Bloodborne Pathogens and Infection Control Training 11 <br /> Contact Hours:1 Completion Date:01/26/2023 <br /> CE Broker Course ID:725950 <br /> CE Broker Provider ID:23363 <br /> Other Course ID (if any):6-0030-12-23-024 <br /> Other Provider ID (if any):6-0030-12-23 <br /> Additional Details: Approved by FL Board of Nursing <br /> Instructor Signature:Instructor:Nurse Administrato : Am Adkins-Dwivedi, CNP <br /> PROVIDERSHIP DETAILS <br /> Continuing <br /> n= # 1 PREMIERE Education <br /> P.O. Box 311 <br /> Issaquah, WA 98027 <br /> 571-327-1637 <br /> supportCp_re mi erece.com <br /> www.premierece.com <br /> Cer:i`icate ID: 81931 <br />
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