JAKE MICHAEL JOHNSON
Physician Assistant


Address: 21 Vista Dr, Shelton, CT 06484-1696

JAKE MICHAEL JOHNSON (Credential# 1669649) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is May 1, 2020. The license expiration date date is April 30, 2021. The license status is ACTIVE.

Business Overview

JAKE MICHAEL JOHNSON is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.004557. The credential type is physician assistant. The effective date is May 1, 2020. The expiration date is April 30, 2021. The business address is 21 Vista Dr, Shelton, CT 06484-1696. The current status is active.

Basic Information

Licensee Name JAKE MICHAEL JOHNSON
Credential ID 1669649
Credential Number 23.004557
Credential Type Physician Assistant
Business Address 21 Vista Dr
Shelton
CT 06484-1696
Business Type INDIVIDUAL
Status ACTIVE - CURRENT
Active 1
Issue Date 2019-08-07
Effective Date 2020-05-01
Expiration Date 2021-04-30
Refresh Date 2020-02-07

Other licenses

ID Credential Code Credential Type Issue Term Status
1682062 CSP.0072195 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER 2019-08-08 2019-08-08 - 2021-02-28 ACTIVE

Office Location

Street Address 21 VISTA DR
City SHELTON
State CT
Zip Code 06484-1696

Licenses in the same zip code

Licensee Name Office Address Credential Effective / Expiration
Scott J Kudravy 2a Garden Ter, Shelton, CT 06484 Radiographer 2020-08-01 ~ 2021-07-31
Melissa E Filanowski 265 Mohegan Rd, Shelton, CT 06484 Licensed Practical Nurse 2020-09-01 ~ 2021-08-31
Danuta Adamson · Chmiel 101 Dickinson Drive, Shelton, CT 06484 Registered Nurse 2020-09-01 ~ 2021-08-31
Sandra E Mercier 234 Deer Run, Huntington, CT 06484 Hairdresser/cosmetician 2020-09-01 ~ 2022-08-31
Ping Li 17 Coram Rd 3c, Shelton, CT 06484 Nail Technician ~
Victoria Mary Bucci 53 Isinglass Rd, Shelton, CT 06484 Master's Level Social Worker ~
Samuel L Smith 122 Maple Avenue, Shelton, CT 06484 Dietitian/nutritionist 2020-08-01 ~ 2021-07-31
Cindy Hubbell Vidal 17 Sherwood Lane, Shelton, CT 06484 Hairdresser/cosmetician 2020-09-01 ~ 2022-08-31
Rosa Conners 189 Coram Avenue, Shelton, CT 06484 Combination Nail Technician, Esthetician Or Eyelash Technici ~
Erica Azzarito 40 Clinton Drive, Shelton, CT 06484 Notary Public Appointment 2020-08-01 ~ 2025-07-31
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Competitor

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City SHELTON
Zip Code 06484
License Type Physician Assistant
License Type + County Physician Assistant + SHELTON

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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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