STEPHANIE G DIBBLE (Credential# 1472163) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is July 1, 2020. The license expiration date date is June 30, 2021. The license status is ACTIVE.
STEPHANIE G DIBBLE is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.004043. The credential type is physician assistant. The effective date is July 1, 2020. The expiration date is June 30, 2021. The business address is 271 Bella Vista Dr, Watertown, CT 06795-1360. The current status is active.
| Licensee Name | STEPHANIE G DIBBLE |
| Credential ID | 1472163 |
| Credential Number | 23.004043 |
| Credential Type | Physician Assistant |
| Business Address |
271 Bella Vista Dr Watertown CT 06795-1360 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2018-02-27 |
| Effective Date | 2020-07-01 |
| Expiration Date | 2021-06-30 |
| Refresh Date | 2020-06-24 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1495444 | CSP.0067523 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2018-03-01 | 2019-03-01 - 2021-02-28 | ACTIVE |
| 1200867 | 70.017159 | Emergency Medical Technician | 2014-01-22 | 2014-01-22 - 2016-06-30 | INACTIVE |
| Street Address | 271 BELLA VISTA DR |
| City | WATERTOWN |
| State | CT |
| Zip Code | 06795-1360 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Kristina D Dibble | 271 Bella Vista Dr, Watertown, CT 06795-1360 | Emergency Medical Technician | 2016-08-05 ~ 2019-06-30 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Taylor Mia Lundy | 265 Kimberly Ln, Watertown, CT 06795 | Registered Nurse | 2020-06-27 ~ 2020-11-30 |
| Judith A Hill | 23 Malvern Hill Road, Watertown, CT 06795 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Carol Mancini Dumond | 57 Bryant, Watertown, CT 06795 | Chiropractor | 2020-07-01 ~ 2021-06-30 |
| Michelle J Stankus | 119 Edge Road, Watertown, CT 06795 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Linda Z Terenzo · Grella | 215 Claxton Ave., Watertown, CT 06795 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Egbrid T30 Pr 9358 | 856 Echo Lake Rd, Watertown, CT 06795 | Medical Marijuana Producer Brand Registration | 2020-06-26 ~ |
| Ana L Guaman | 1278 Main Street Ste 4, Watertown, CT 06795 | Nail Technician | ~ |
| Eric A Tymula | 727 Park Rd, Watertown, CT 06795 | Tattoo Technician | 2020-03-01 ~ 2022-02-28 |
| Margaret A Chilson | 259 Litchfield Road, Watertown, CT 06795 | Massage Therapist | 2020-05-01 ~ 2022-04-30 |
| Laura L Rock | 187 Georgetown Drive, Watertown, CT 06795 | Notary Public Appointment | 2020-06-01 ~ 2025-05-31 |
| Find all Licenses in zip 06795 | |||
| City | WATERTOWN |
| Zip Code | 06795 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + WATERTOWN |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Dibble Hollow II LLC | 74 Barber Hill Rd, Broad Brook, CT 06016 | New Home Construction Contractor | 1999-10-01 ~ 2001-09-30 |
| Stephanie E Beierle | 12 Dewal Dr, Norwalk, CT 06851-1227 | Physician Assistant | 2020-07-01 ~ 2021-06-30 |
| Stephanie Jamie Pham | 245 5th Ave Floor 3, New York, NY 10016 | Physician Assistant | ~ |
| Stephanie A Mckinney | 423 E 83rd St Apt 3b, New York, NY 10028-5520 | Physician Assistant | 2011-10-01 ~ 2012-09-30 |
| Stephanie M Lepage Pa | 534 Thrall Ave, Suffield, CT 06078 | Physician Assistant | 2010-08-01 ~ 2011-07-31 |
| Stephanie Chawla | 761 Main Ave Ste 201, Norwalk, CT 06851-1080 | Physician Assistant | 2020-03-01 ~ 2021-02-28 |
| Stephanie Carroll Pa | 166 Linden St Apt #b-6, New Haven, CT 06511 | Physician Assistant | 2007-08-01 ~ 2008-09-30 |
| Stephanie F Behrens | 3 Knollwood Rd, Farmington, CT 06032 | Physician Assistant | 2020-03-01 ~ 2021-02-28 |
| Stephanie B Fridman Pa-c | 39 Beekman St Fl 4, New York, NY 10038-1521 | Physician Assistant | 2012-08-01 ~ 2013-07-31 |
| Stephanie R Levy Pa-c | 30 Amherst Court, Mystic, CT 06355 | Physician Assistant | 2010-09-01 ~ 2011-08-31 |
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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).