BETTY WHITE HEALTH CENTER
Graduate Nursing Program
Adult-Gerontology Primary Care DNP Program
Practicum Sites Preceptors
Facility Name ___
Address ___
City, State, Zip ___
Phone Number ___
Type of site (rural clinic, private practice, health department, hospital clinic, educational institution) Characteristics of Patient/Care/Learners (gender, age, ethnicity) Experience Available
| Name and credentials of Preceptor | Practice Specialty | Certification (Certifying agency and expiration date) | Years of Practice in Specialty Area | Previously Preceptor for NP/DNP Students (Y/N) | State Licensure Number and Expiration Date |
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