NICOLE ANN DIETZEL
Physician Assistant


Address: 94 Hawthorne Dr, Southington, CT 06489-2818

NICOLE ANN DIETZEL (Credential# 1679198) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is September 1, 2020. The license expiration date date is August 31, 2021. The license status is ACTIVE.

Business Overview

NICOLE ANN DIETZEL is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.004636. The credential type is physician assistant. The effective date is September 1, 2020. The expiration date is August 31, 2021. The business address is 94 Hawthorne Dr, Southington, CT 06489-2818. The current status is active.

Basic Information

Licensee Name NICOLE ANN DIETZEL
Credential ID 1679198
Credential Number 23.004636
Credential Type Physician Assistant
Business Address 94 Hawthorne Dr
Southington
CT 06489-2818
Business Type INDIVIDUAL
Status ACTIVE - CURRENT
Active 1
Issue Date 2019-10-11
Effective Date 2020-09-01
Expiration Date 2021-08-31
Refresh Date 2020-06-13

Other licenses

ID Credential Code Credential Type Issue Term Status
1798860 CSP.0072612 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER 2019-10-15 2019-10-15 - 2021-02-28 ACTIVE

Office Location

Street Address 94 HAWTHORNE DR
City SOUTHINGTON
State CT
Zip Code 06489-2818

Licenses in the same zip code

Licensee Name Office Address Credential Effective / Expiration
Hdl Handyman Service LLC 46 Hawthorne Dr, Southington, CT 06489-2818 Home Improvement Contractor 2012-12-01 ~ 2013-11-30

Licenses in the same zip code

Licensee Name Office Address Credential Effective / Expiration
Sarah M Moon 321 Pilgrim Lane, Southington, CT 06489 Esthetician ~
Joanna Milewski 23 Stacy Cate Drive, Southington, CT 06489 Registered Nurse 2020-07-01 ~ 2021-06-30
Richard M Testa 81 Winter Park Road, Southington, CT 06489 Massage Therapist 2020-08-01 ~ 2022-07-31
Valley Roofing LLC 88 Ladyslipper Lane, Southington, CT 06489 Home Improvement Contractor ~
Dunkin Donuts · New England Donuts LLC 856 Queen St, Southington, CT 06489 Bakery 2020-07-01 ~ 2021-06-30
Elizabeth E Pizzuto 45 Water Street, Southington, CT 06489 Real Estate Salesperson 2020-06-18 ~ 2021-05-31
Nicholas C Ingel 515 West Street, Southington, CT 06489 Heating, Piping & Cooling Limited Journeyperson 2020-06-23 ~ 2021-08-31
Tyrone J Correa 84 Minthal Drive, Southington, CT 06489 Real Estate Salesperson 2020-06-19 ~ 2021-05-31
Marilyn F Coppola 114 Spring Hill Rd, Southington, CT 06489 Registered Nurse 2020-08-01 ~ 2021-07-31
Christine M Liebler 30 Sultana Terrace, Southington, CT 06489 Registered Nurse 2020-07-01 ~ 2021-06-30
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Competitor

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City SOUTHINGTON
Zip Code 06489
License Type Physician Assistant
License Type + County Physician Assistant + SOUTHINGTON

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Dataset Information

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).

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