HEATHER ELIZABETH DIVERSI (Credential# 1648770) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2020. The license expiration date date is February 28, 2021. The license status is ACTIVE.
HEATHER ELIZABETH DIVERSI is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.004488. The credential type is physician assistant. The effective date is March 1, 2020. The expiration date is February 28, 2021. The business address is 55 Box Mountain Dr, Vernon, CT 06066-6304. The current status is active.
| Licensee Name | HEATHER ELIZABETH DIVERSI |
| Credential ID | 1648770 |
| Credential Number | 23.004488 |
| Credential Type | Physician Assistant |
| Business Address |
55 Box Mountain Dr Vernon CT 06066-6304 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2019-06-12 |
| Effective Date | 2020-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2020-02-03 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1668609 | CSP.0071539 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2019-06-13 | 2019-06-13 - 2021-02-28 | ACTIVE |
| 1668608 | CSP.0071538 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | - | PENDING |
| Street Address | 55 BOX MOUNTAIN DR |
| City | VERNON |
| State | CT |
| Zip Code | 06066-6304 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Christine Pender | 25 Box Mountain Dr, Vernon, CT 06066-6304 | Occupational Therapist | 2019-08-01 ~ 2021-07-31 |
| Paul R Collin | 97 Box Mountain Dr, Vernon, CT 06066-6304 | Electrical Unlimited Contractor | 2019-10-01 ~ 2020-09-30 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Cynthia Stelma | 35 White St, Vernon, CT 06066 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Diana C Mendieta | 127 Lake St, Vernon, CT 06066 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-26 ~ 2022-02-28 |
| Taylor Rose Mulcahy | 95 Hockanum Blvd Unit #5223, Vernon, CT 06066 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Eric Scott · E Scott Const | 27 Lawrence St, Vernon Rockville, CT 06066 | Home Improvement Contractor | 2020-06-20 ~ 2020-11-30 |
| Margaret A Lucerini | 27 Rosewood Dr, Vernon, CT 06066 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Alexander John Bozzi | 28 Deepwood Dr, Vernon, CT 06066 | Home Inspector Intern | 2020-05-30 ~ 2021-06-30 |
| Kathleen N Laplaca | 244 Risley Road, Vernon, CT 06066 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Shawnda Shelton | 215 East Main St. #25, Vernon, CT 06066 | Medication Administration Certification | 2020-06-05 ~ 2022-06-04 |
| Ireland Oil Co Inc | 171 Union St, Vernon, CT 06066 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Annmarie Margaret Fultz | 1a Prospect St, Vernon Rockville, CT 06066 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Find all Licenses in zip 06066 | |||
| City | VERNON |
| Zip Code | 06066 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + VERNON |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Heather Bryant | 851 Ne 1st Ave, Miami, FL 33132 | Physician Assistant | 2018-10-30 ~ 2019-04-30 |
| Crystal A Huynh | 14 Heather Ln, Wilton, CT 06897-4132 | Physician Assistant | 2013-05-22 ~ 2013-11-30 |
| Heather Nickerson | 308 Killingworth Rd, Higganum, CT 06441 | Physician Assistant | 2020-09-01 ~ 2021-08-31 |
| Heather M Rynkowski | 16 Hillwood Dr, Niantic, CT 06357-1823 | Physician Assistant | 2020-08-01 ~ 2021-07-31 |
| Heather M Tomchik | 12 Quail Run Dr, Danbury, CT 06811-5128 | Physician Assistant | 2020-06-01 ~ 2021-05-31 |
| Heather M Peterson | 31 Delmor Ave, Wilbraham, MA 01095-1554 | Physician Assistant | 2013-10-04 ~ 2014-07-31 |
| Heather A Shackett | 185 Pine St #617, Manchester, CT 06040 | Physician Assistant | 1994-03-14 ~ 1995-03-31 |
| Heather L Storms Pa | 33 Hospital Ave, Danbury, CT 06810 | Physician Assistant | 2004-03-23 ~ 2005-05-31 |
| Heather A Bowdre | 40 Prospect Ave, Norwalk, CT 06850-3737 | Physician Assistant | 2010-07-01 ~ 2011-06-30 |
| Heather A Hooper | 729 Quinnipiac Ave, New Haven, CT 06513 | Physician Assistant | 1996-01-29 ~ 1997-02-28 |
Please comment or provide details below to improve the information on HEATHER ELIZABETH DIVERSI.
| 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).