KYLIE TANABE (Credential# 1294451) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is May 1, 2016. The license expiration date date is April 30, 2017. The license status is INACTIVE.
KYLIE TANABE is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.003407. The credential type is physician assistant. The effective date is May 1, 2016. The expiration date is April 30, 2017. The business address is 40 Prospect Ave, Norwalk, CT 06850-3737. The current status is inactive.
| Licensee Name | KYLIE TANABE |
| Credential ID | 1294451 |
| Credential Number | 23.003407 |
| Credential Type | Physician Assistant |
| Business Address |
40 Prospect Ave Norwalk CT 06850-3737 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2015-08-12 |
| Effective Date | 2016-05-01 |
| Expiration Date | 2017-04-30 |
| Refresh Date | 2017-08-03 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1307454 | CSP.0061383 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2015-08-27 | 2015-08-27 - 2017-02-28 | INACTIVE |
| Street Address | 40 PROSPECT AVE |
| City | NORWALK |
| State | CT |
| Zip Code | 06850-3737 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Allan A Lambkin | 40 Prospect Ave, Norwalk, CT 06850-3737 | Resident Physician | 2018-06-25 ~ 2021-06-30 |
| Astha Tejpal | 40 Prospect Ave, Norwalk, CT 06850-3737 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Rekha M Reddy | 40 Prospect Ave, Norwalk, CT 06850-3737 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Sivraj Muralikrishnan | 40 Prospect Ave, Norwalk, CT 06850-3737 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| Daniel Wallace Dahl | 40 Prospect Ave, Norwalk, CT 06850 | Physician/surgeon | 2018-01-01 ~ 2018-12-31 |
| Molly S Van Dams | 40 Prospect Ave, Norwalk, CT 06850 | Occupational Therapist | 2015-08-01 ~ 2017-07-31 |
| Brienne M Chow | 40 Prospect Ave, Norwalk, CT 06850 | Registered Nurse | 2016-05-01 ~ 2017-04-30 |
| Prakriti S Merchant | 40 Prospect Ave, Norwalk, CT 06850-3737 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Adrienne Berkowitz | 40 Prospect Ave, Norwalk, CT 06850-3737 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Henry Chow | 40 Prospect Ave, Norwalk, CT 06850 | Controlled Substance Registration for Practitioner | 2015-07-02 ~ 2017-02-28 |
| Find all Licenses in the same address | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Amanda Lindo | 40 Prospect Ave Bldg 3j, Norwalk, CT 06850-3737 | Resident Physician | 2020-07-01 ~ 2022-06-30 |
| Angad Deengar | 40 Prospect Ave Bldg 4k, Norwalk, CT 06850-3737 | Resident Physician | 2020-07-01 ~ 2023-06-30 |
| Juan C Sarmiento Ramon | 40 Prospect Ave Bldg 3l, Norwalk, CT 06850-3737 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Carlos M Nunez | 40 Prospect Ave Bldg 3a, Norwalk, CT 06850-3737 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Di Wu | 40 Prospect Ave Bldg 4d, Norwalk, CT 06850-3737 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Yousaf A Shaikh | 40 Prospect Ave Apt 3d, Norwalk, CT 06850-3737 | Resident Physician | 2018-06-20 ~ 2021-06-19 |
| Mufti Mushfiqur Rahman | 40 Prospect Ave Bldg 3f, Norwalk, CT 06850-3737 | Resident Physician | 2017-06-20 ~ 2021-06-19 |
| Sharon Sukhdeo | 40 Prospect Ave Bldg 3k, Norwalk, CT 06850-3737 | Resident Physician | 2017-06-19 ~ 2021-06-30 |
| Virginia Ruiz | 40 Prospect Ave Bldg 4l, Norwalk, CT 06850-3737 | Resident Physician | 2019-11-11 ~ 2022-11-10 |
| Rodney Jake Teichroeb | 40 Prospect Ave Bldg 1-k, Norwalk, CT 06850-3737 | Resident Physician | 2018-06-25 ~ 2021-06-30 |
| Find all Licenses in zip 06850-3737 | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Maria L Volpe | 31 Geneva Road, West Norwalk, CT 06850 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| Rhonda Teel | 96 Stuart Avenue, Norwalk, CT 06850 | Notary Public Appointment | 2020-07-01 ~ 2025-06-30 |
| Jill Goldberg Aprn | 1 Bonnybrook Road, Norwalk, CT 06850 | Advanced Practice Registered Nurse | 2020-05-01 ~ 2021-04-30 |
| Allen D Sanchez | 22 Newfield St, Norwalk, CT 06850 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| John B Howell | 16 Forest Hill Road, Norwalk, CT 06850 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Ting Chen | Seven Nails Spa 99 New Canaan Ave, Norwalk, CT 06850 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Vincent Grasso | 21 Rae Lane, Norwalk, CT 06850 | Architect | 2020-08-01 ~ 2021-07-31 |
| Karen G Nicolas | 16 Orange St, Norwalk, CT 06850 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Amarely Sanchez | 139 Stuart Ave, Norwalk, CT 06850 | Nail Technician | ~ |
| Lance E Zimmerman | 14 Cliffview Dr, Norwalk, CT 06850 | Architect | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06850 | |||
| City | NORWALK |
| Zip Code | 06850 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + NORWALK |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Kylie M Bister | 59 Hodge Rd, Marlborough, CT 06447-1306 | Physical Therapist Assistant | 2019-08-01 ~ 2020-07-31 |
| Kylie's Kandy | 90 Elm St, Enfield, CT 06082-3770 | Lottery Sales Agent | 2014-04-09 ~ 2015-03-31 |
| Kylie's Bakery · Cassidy's Diner 2 LLC | 3 Turkey Hills Rd Suite 3l, East Granby, CT 06026 | Bakery | 2006-07-01 ~ 2007-06-30 |
| Kan Tanabe | 40 Shailer Pond Rd, Deep River, CT 06417-1568 | Home Improvement Salesperson | 2019-11-21 ~ 2020-11-30 |
| 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 |
| Theresa V Horvath | Physiican Assistant Institute, Bridgeport, CT 06604 | Physician Assistant | 2018-10-01 ~ 2019-09-30 |
| Quinnipiac University Physician Assistant Student Society | 370 Bassett Rd, North Haven, CT 06473-4201 | Raffle Permit Class 1 | 2017-01-12 ~ 2017-04-08 |
| Connecticut Dermatology Physician Assistant Society Inc. | Po Box 847, Manchester, CT 06045 | Public Charity-exempt From Financial Requirements | ~ |
| Gretchen Treves | Physician One Urgent Care, Brookfield, CT 06804 | Physician Assistant | ~ |
| Dutton Estate Winery Kylie's Cuvee Sauvignon Blanc Russian River Valley | Connecticut Brand Registration, Hartford, CT 06106 | Liquor Brand Label | 2008-01-18 ~ 2011-01-17 |
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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).