CHARLES R PARK (Credential# 741750) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is October 1, 2016. The license expiration date date is September 30, 2017. The license status is INACTIVE.
CHARLES R PARK is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.000001. The credential type is physician assistant. The effective date is October 1, 2016. The expiration date is September 30, 2017. The business address is 1283 Whirlwind Hill Rd, Wallingford, CT 06492. The current status is inactive.
| Licensee Name | CHARLES R PARK |
| Credential ID | 741750 |
| Credential Number | 23.000001 |
| Credential Type | Physician Assistant |
| Business Address |
1283 Whirlwind Hill Rd Wallingford CT 06492 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 1993-06-25 |
| Effective Date | 2016-10-01 |
| Expiration Date | 2017-09-30 |
| Refresh Date | 2018-01-03 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 434149 | CSP.0038998 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2006-04-10 | 2015-03-01 - 2017-02-28 | INACTIVE |
| 164238 | CSP.0021362 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2006-03-01 | 2006-03-01 - 2007-02-28 | INACTIVE |
| Street Address | 1283 WHIRLWIND HILL RD |
| City | WALLINGFORD |
| State | CT |
| Zip Code | 06492 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Andrea Zola | 53 Alison Ave., Wallingford, CT 06492 | Esthetician | ~ |
| Kyungok Choi | 90 Ward St, Wallingford, CT 06492 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Giang Nguyen | 45 Country Club Lane, Wallingford, CT 06492 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-27 ~ 2021-11-30 |
| Lc Artistry | 207 North Colony Road, Wallingford, CT 06492 | Esthetician | ~ |
| Katie Lee | 20 Angela Dr, Wallingford, CT 06492 | Paramedic | 2020-09-01 ~ 2021-08-31 |
| Vinny's Deli | 567 Center St, Wallingford, CT 06492 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Michele Ruggiero | 26 Leigus Road, Wallingford, CT 06492 | Radiographer | 2020-07-01 ~ 2021-06-30 |
| Dianna K Ball | 104 Simpson Ave, Wallingford, CT 06492 | Speech and Language Pathologist | 2020-08-01 ~ 2021-07-31 |
| Ann Marie Richardson | 20 Mohawk Drive, Wallingford, CT 06492 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Joann Hummel | 60 Deer Run Road, Wallingford, CT 06492 | Medication Administration Certification | 2018-08-21 ~ 2020-08-20 |
| Find all Licenses in zip 06492 | |||
| City | WALLINGFORD |
| Zip Code | 06492 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + WALLINGFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Charles Edward | 99 26 193 St, Hollis, NY 11423-3216 | Physician Assistant | 2011-12-12 ~ 2012-08-31 |
| Charles M Andola IIi Pa | 204 Wardwell St, Stamford, CT 06902-5247 | Physician Assistant | 2020-03-01 ~ 2021-02-28 |
| Charles J Severo | 115 Beachland Avenue, Milford, CT 06460 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
| Charles Joseph Braun Jr. | 103 Ash Street, Cortlandt Manor, NY 10567 | Physician Assistant | ~ |
| Charles Dupaix | 40 Prospect Ave Bldg #1 Apt 4-f, Norwalk, CT 06850-3737 | Physician Assistant | 2016-05-01 ~ 2017-04-30 |
| Charles A Engle | 9 Humber Hill Rd, Danbury, CT 06810-5172 | Physician Assistant | 2020-08-01 ~ 2021-07-31 |
| Janine J Zawisny | 159 Charles Ave, Staten Island, NY 10302 | Physician Assistant | 2010-01-13 ~ 2010-07-31 |
| Charles Robert Barnes | 112 Baker St, Johnson City, NY 13790-1904 | Physician Assistant | 2016-07-21 ~ 2017-07-31 |
| Charles Barnicoat Pa | 4483 Snowy Egret Drive, Naples, FL 34119 | Physician Assistant | 2011-02-01 ~ 2012-01-31 |
| Charles F Roe | 201 S Park Lane, Altus, OK 73521 | Physician/surgeon | 1981-01-01 ~ 1987-02-17 |
Please comment or provide details below to improve the information on CHARLES R PARK.
| 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).