JACQUELINE S NISSEN (Credential# 550150) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is June 1, 2020. The license expiration date date is May 31, 2021. The license status is ACTIVE.
JACQUELINE S NISSEN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.032545. The credential type is physician/surgeon. The effective date is June 1, 2020. The expiration date is May 31, 2021. The business address is 263 Farmington Ave # Mc1921, Farmington, CT 06030-0001. The current status is active.
| Licensee Name | JACQUELINE S NISSEN |
| Credential ID | 550150 |
| Credential Number | 1.032545 |
| Credential Type | Physician/Surgeon |
| Business Address |
263 Farmington Ave # Mc1921 Farmington CT 06030-0001 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1992-08-21 |
| Effective Date | 2020-06-01 |
| Expiration Date | 2021-05-31 |
| Refresh Date | 2020-04-04 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 163597 | CSP.0022083 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 1999-03-29 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 263 FARMINGTON AVE # MC1921 |
| City | FARMINGTON |
| State | CT |
| Zip Code | 06030-0001 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Varshitha P Thanikonda | 263 Farmington Ave # Mc1921, Farmington, CT 06030-0001 | Resident Physician | 2018-06-28 ~ 2021-06-30 |
| Alfredo Garcia | 263 Farmington Ave # Mc1921, Farmington, CT 06030-0001 | Resident Physician | 2018-06-28 ~ 2021-06-30 |
| Daniel M Guevara-pineda | 263 Farmington Ave # Mc1921, Farmington, CT 06030-0001 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Hanxiang A Wang | 263 Farmington Ave # Mc1921, Farmington, CT 06030-0001 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Meghan E Snuckel | 263 Farmington Ave # Mc1921, Farmington, CT 06030-0001 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Subtain A Zia | 263 Farmington Ave # Mc1921, Farmington, CT 06030-0001 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Jordan A Borgman | 263 Farmington Ave # Mc1921, Farmington, CT 06030-0001 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Komalben Pravinbhai Parmar | 263 Farmington Ave # Mc1921, Farmington, CT 06030-0001 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Wendy A Miller | Mc1921 Farmington Ave # 263, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Jason J Ziegler | 2 Courthouse Square, Farmington, CT 06030-0001 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Bryden T Considine | L2104 of Medicine Rm, Farmington, CT 06030-0001 | Resident Physician | 2017-07-03 ~ 2021-06-30 |
| Dillon Paulo | 4260 Cordoba Ct, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Erica Shen Nofziger | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2027-06-30 |
| Omar Ibrahim | 263 Farmington Ave # Mc-1321, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Jillian L Fortier | Uconn Health Center, Department of Surgery, Farmington, CT 06030-0001 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Douglas Zelisko | 263 Farmington Ave Dept Of, Farmington, CT 06030-0001 | Physician/surgeon | 2020-04-23 ~ 2021-01-31 |
| Ruchir D Trivedi | 263 Farmington Ave # Mc-1405, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Rawan J.j. Sarsour | 263 Farmington Ave # Mc3905, Farmington, CT 06030-0001 | Provisional Faculty Dentist | 2020-04-21 ~ 2021-04-30 |
| Find all Licenses in zip 06030-0001 | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Eric Anthony Brueckner | 263 Farmington Ave., Farmington, CT 06030 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Derrick B Bremang | Residency Program, Farmington, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-06-30 |
| David M Shafer | Uconn Health Center, Farmington, CT 06030 | Dentist | 2020-07-01 ~ 2021-06-30 |
| Michael J Murphy | Dept of Dermatology, Farmington, CT 06030 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Richard F Kaplan | Univ. of Ct., Farmington, CT 06030 | Psychologist | 2020-06-01 ~ 2021-05-31 |
| Nicholas George Vitale | 22 Woods Drive, Norwich, CT 06030 | Casino Class I Employee | 2019-12-03 ~ 2020-10-31 |
| Bruce E Gould | Univ of Conn Health Center, Farmington, CT 06030 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Vinayak M Sathe | Uconn Health Center,263 Farmington Ave, Farmington, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Shobhana Pathani | Department of Medicine, 263 Farmington Ave, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Patricia L Almeida | John Dempsey Hospital, Farmington, CT 06030 | Registered Nurse | 2020-04-01 ~ 2021-03-31 |
| Find all Licenses in zip 06030 | |||
| City | FARMINGTON |
| Zip Code | 06030 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + FARMINGTON |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Carl W Nissen Md | 35 Mountain Spring Rd, Farmington, CT 06032 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| J J Nissen Baking Co Inc | 817 Dexter Street, Central Fall, RI 02863 | Bakery | 1998-07-01 ~ 1999-06-30 |
| John J Nissen Baking Co | 59 Washington Avenue, Portland, ME 04104 | Bakery | 1998-07-01 ~ 1999-06-30 |
| John J Nissen Baking Co | 34 Abbot St, Brewer, ME 04412 | Bakery | ~ |
| John J Nissen Baking Co Inc | 75 Quinsigamond Ave, Worcester, MA 06610 | Bakery | 1997-07-01 ~ 1998-06-30 |
| Jacqueline J Littzi | New Canaan, CT 06840 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Jacqueline E. Bavaro | 11 Jordan Ln, Ardsley, NY 10502-1313 | Physician/surgeon | ~ |
| Jacqueline E Ramchatesingh Md | 420 E Main St #6, Branford, CT 06405 | Physician/surgeon | 2006-02-10 ~ 2006-12-31 |
| Jacqueline M Lewis | P.o. Box 1833, New Rochelle, NY 10802 | Physician/surgeon | 2007-02-01 ~ 2008-01-31 |
| Jacqueline J Janka | 392 N 2969th Rd, La Salle, IL 61301-9705 | Physician/surgeon | 2015-05-01 ~ 2016-04-30 |
Please comment or provide details below to improve the information on JACQUELINE S NISSEN.
| 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).