JACQUELINE R BRAUNWORTH (Credential# 1256210) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2020. The license expiration date date is February 28, 2021. The license status is ACTIVE.
JACQUELINE R BRAUNWORTH is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.003273. The credential type is physician assistant. The effective date is March 1, 2020. The expiration date is February 28, 2021. The business address is 68 Division St, Derby, CT 06418-1447. The current status is active.
| Licensee Name | JACQUELINE R BRAUNWORTH |
| Credential ID | 1256210 |
| Credential Number | 23.003273 |
| Credential Type | Physician Assistant |
| Business Address |
68 Division St Derby CT 06418-1447 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2015-02-04 |
| Effective Date | 2020-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2020-01-13 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1266362 | CSP.0059424 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2015-02-10 | 2019-03-01 - 2021-02-28 | ACTIVE |
| 820587 | 69.003164 | Emergency Medical Responder | 2002-12-10 | 2002-12-10 - 2004-09-30 | INACTIVE |
| Street Address | 68 DIVISION ST |
| City | DERBY |
| State | CT |
| Zip Code | 06418-1447 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Medexpress Urgent Care-derby, Division St. | 68 Division St, Derby, CT 06418-1447 | Outpatient Clinic | 2018-11-28 ~ 2021-09-30 |
| Dheeraj Taranath | 68 Division St, Derby, CT 06418-1447 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Christine M Hamilton | 68 Division St, Derby, CT 06418-1447 | Controlled Substance Registration for Practitioner | 2019-10-15 ~ 2021-02-28 |
| Radio Shack #1098 | 68 Division St, Derby, CT 06418 | Tv & Radio Dealer | 2003-09-29 ~ 2004-08-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Hasan Koc · Captain's Pizza Restaurant | 36 Division St, Derby, CT 06418-1447 | Restaurant Wine & Beer | 2012-01-23 ~ 2013-01-19 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Debra A Montini | 8 Academy Hill Ext, Derby, CT 06418 | Dental Hygienist | 2020-08-01 ~ 2021-07-31 |
| Laura M Boanno | 131 Marshall La, Derby, CT 06418 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Danyun Chen | 49 Pershing Dr., Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Fan Geng | Shoprite Shopping Center, Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Danni Xu | Shoprite Shopping Center49 Pershing Dr, Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Yao Zhang | Shoprite Shopping Center 49 Pershing Dr, Derby, CT 06418 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Phillip N Burke | 3 Camptown St, Derby, CT 06418 | Emergency Medical Technician | 2017-06-07 ~ 2020-06-30 |
| Diane A Rosner | 229 Shagbark Drive, Derby, CT 06418 | Professional Counselor | 2020-08-01 ~ 2021-07-31 |
| Pamela C Lavelle | 194 Minerva St, Derby, CT 06418 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Grade A Market - Derby LLC | 49 Pershing Dr, Derby, CT 06418 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06418 | |||
| City | DERBY |
| Zip Code | 06418 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + DERBY |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Jacqueline J Jervis | 281 Seaside Ave, Milford, CT 06460-4601 | Physician Assistant | 2020-05-01 ~ 2021-04-30 |
| Jacqueline Tricarico | 81 Nunan Street, Charleston, SC 29403 | Physician Assistant | ~ |
| Jacqueline P Talbot Pa | 22 Woodridge Ln, New Fairfield, CT 06812-5033 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
| 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 |
| 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 |
| Jacqueline H Hopkinson | 4 Shannon Dr., Stratham, NH 03885 | Physical Therapist Assistant | ~ 2006-11-01 |
| Jacqueline M Armstrong | 5 Nancy Ln, Middlefield, CT 06455-1228 | Physical Therapist Assistant | 2020-06-01 ~ 2021-05-31 |
Please comment or provide details below to improve the information on JACQUELINE R BRAUNWORTH.
| 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).