JACQUELINE J JERVIS (Credential# 1233999) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is May 1, 2020. The license expiration date date is April 30, 2021. The license status is ACTIVE.
JACQUELINE J JERVIS is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.003136. The credential type is physician assistant. The effective date is May 1, 2020. The expiration date is April 30, 2021. The business address is 281 Seaside Ave, Milford, CT 06460-4601. The current status is active.
| Licensee Name | JACQUELINE J JERVIS |
| Credential ID | 1233999 |
| Credential Number | 23.003136 |
| Credential Type | Physician Assistant |
| Business Address |
281 Seaside Ave Milford CT 06460-4601 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2014-07-11 |
| Effective Date | 2020-05-01 |
| Expiration Date | 2021-04-30 |
| Refresh Date | 2020-03-25 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1234876 | CSP.0058121 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2014-07-16 | 2019-03-01 - 2021-02-28 | ACTIVE |
| 954504 | 70.012773 | Emergency Medical Technician | 2010-09-28 | 2010-09-28 - 2013-06-30 | INACTIVE |
| Street Address | 281 SEASIDE AVE |
| City | MILFORD |
| State | CT |
| Zip Code | 06460-4601 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Dion J Lopez | 275 Seaside Ave # 1, Milford, CT 06460-4601 | Home Improvement Salesperson | ~ 2018-11-30 |
| Tara A Dehart | 253 Seaside Ave, Milford, CT 06460-4601 | Occupational Therapist | 2019-08-01 ~ 2021-07-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Milford Council On Aging | 9 Jepson Drive, Milford, CT 06460 | Public Charity | 2019-06-01 ~ 2020-05-31 |
| James J Melanson | 319 Welch's Point Road, Milford, CT 06460 | Optician | 2020-08-01 ~ 2021-07-31 |
| Robert J Colum | 61 Melba St, Milford, CT 06460 | Professional Engineer | 2020-06-16 ~ 2021-01-31 |
| James E Phillips | 88 Noble Ave, Milford, CT 06460 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Douglas H Gruber | 33 Lincoln Ave, Milford, CT 06460 | Licensed Alcohol and Drug Counselor | 2020-06-01 ~ 2021-05-31 |
| Christine D Rettig | 1 Schooner Lane, Milford, CT 06460 | Physical Therapist | 2020-07-01 ~ 2021-06-30 |
| Golden Dragon Inc | 262 D Quarry Rd, Mildord, CT 06460 | Food Warehouse | ~ |
| Kelli-ann Armstrong | 50 Cherry Street, Milford, CT 06460 | Optometrist | 2020-07-01 ~ 2021-06-30 |
| Mary C Cohen | 9 Stevens Street, Milford, CT 06460 | Notary Public Appointment | 2020-07-01 ~ 2025-06-30 |
| Nicole Wilson | 26 Daggett Street, Milford, CT 06460 | Hairdresser/cosmetician | 2020-08-01 ~ 2022-07-31 |
| Find all Licenses in zip 06460 | |||
| City | MILFORD |
| Zip Code | 06460 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + MILFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jacqueline P Talbot Pa | 22 Woodridge Ln, New Fairfield, CT 06812-5033 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
| Jacqueline R Braunworth | 68 Division St, Derby, CT 06418-1447 | Physician Assistant | 2020-03-01 ~ 2021-02-28 |
| Jacqueline Tricarico | 81 Nunan Street, Charleston, SC 29403 | Physician Assistant | ~ |
| Jacqueline E Rowan | 111 Salem Tpke Ste 7, Norwich, CT 06360-7403 | Physician Assistant | 2020-09-01 ~ 2021-08-31 |
| Jacqueline A Connor | 2150 Main St, Springfield, MA 01104-3566 | Physician Assistant | 2020-05-01 ~ 2021-04-30 |
| Jacqueline Mary Atkinson | 300 Andrews Way, South Windsor, CT 06074 | Physician Assistant | 2020-03-01 ~ 2021-02-28 |
| Jacqueline Nicole Perez | 891 Mountain Rd, West Hartford, CT 06117 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
| Derek L Somerville | 25 Buckley Street, Port Jervis, NY 12771 | Occupational Therapist Assistant | 2008-05-23 ~ 2009-07-31 |
| Edward Orlando | 74 Eagle Crest Rd, Port Jervis, NY 12771-3411 | Physician/surgeon | 2017-10-01 ~ 2018-09-30 |
| Physician Assistant Foundation of The American Academy of Physician Assistants | 2318 Mill Rd Ste 1300, Alexandria, VA 22314-6868 | Public Charity | 2019-12-01 ~ 2020-11-30 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).