JACQUELINE NICOLE PEREZ (Credential# 1671108) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is April 1, 2020. The license expiration date date is March 31, 2021. The license status is ACTIVE.
JACQUELINE NICOLE PEREZ is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.004613. The credential type is physician assistant. The effective date is April 1, 2020. The expiration date is March 31, 2021. The business address is 891 Mountain Rd, West Hartford, CT 06117. The current status is active.
| Licensee Name | JACQUELINE NICOLE PEREZ |
| Credential ID | 1671108 |
| Credential Number | 23.004613 |
| Credential Type | Physician Assistant |
| Business Address |
891 Mountain Rd West Hartford CT 06117 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2019-09-27 |
| Effective Date | 2020-04-01 |
| Expiration Date | 2021-03-31 |
| Refresh Date | 2020-02-26 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1790092 | CSP.0072512 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2019-10-01 | 2019-10-01 - 2021-02-28 | ACTIVE |
| Street Address | 891 Mountain Rd |
| City | West Hartford |
| State | CT |
| Zip Code | 06117 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Cathy Tran | 20 Lindy Lane, West Hartford, CT 06117 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Renaissance Craftsmen LLC | 263 Simsbury Road, West Hartford, CT 06117 | Home Improvement Contractor | 2020-06-27 ~ 2020-11-30 |
| Lev Tsarkov | 116 Lyman Road, West Hartford, CT 06117 | Registered Nurse | 2020-06-01 ~ 2021-05-31 |
| Scott Lee Ratchford | 67 Balfour Dr., West Hartford, CT 06117 | Professional Counselor | ~ |
| Gary Neidle | 8 Stratford Rd, West Hartford, CT 06117 | Real Estate Salesperson | 2020-06-26 ~ 2021-05-31 |
| Beverly Vincent | 37 Harwich Lane, West Hartford, CT 06117 | Hairdresser/cosmetician | 2020-07-01 ~ 2022-06-30 |
| Marc D Palter | 94 Beacon Hill Dr, West Hartford, CT 06117 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| David L Friar | 35 Porter Dr, W Hartford, CT 06117 | Architect | 2020-08-01 ~ 2021-07-31 |
| Adlin C Daye | 147 Mohawk Drive, West Hartford, CT 06117 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Derek M Mcdermott | 61 Ferncliff Drive, West Hartford, CT 06117 | Emergency Medical Technician | ~ |
| Find all Licenses in zip 06117 | |||
| City | West Hartford |
| Zip Code | 06117 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + West Hartford |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| 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 R Braunworth | 68 Division St, Derby, CT 06418-1447 | Physician Assistant | 2020-03-01 ~ 2021-02-28 |
| Jacqueline J Jervis | 281 Seaside Ave, Milford, CT 06460-4601 | Physician Assistant | 2020-05-01 ~ 2021-04-30 |
| 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 |
| Courtney Nicole Enos | 916 1/2 4th St Ne, Byron, MN 55920-1530 | Physician Assistant | ~ |
| Nicole R Ciccia | 71 Joy Rd Apt C, Milford, CT 06460-6052 | Physician Assistant | 2020-06-01 ~ 2021-05-31 |
| Jaime A Camacho | 6 Nicole Ln, Burlington, CT 06013-2123 | Physician Assistant | 2020-03-01 ~ 2021-02-28 |
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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).