SAM TAYLOR PA (Credential# 742344) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is August 1, 2014. The license expiration date date is July 31, 2015. The license status is INACTIVE.
SAM TAYLOR PA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.000595. The credential type is physician assistant. The effective date is August 1, 2014. The expiration date is July 31, 2015. The business address is 95169 Douglas Rd, Fernandina Beach, FL 32034-1268. The current status is inactive.
| Licensee Name | SAM TAYLOR PA |
| Credential ID | 742344 |
| Credential Number | 23.000595 |
| Credential Type | Physician Assistant |
| Business Address |
95169 Douglas Rd Fernandina Beach FL 32034-1268 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 1996-10-18 |
| Effective Date | 2014-08-01 |
| Expiration Date | 2015-07-31 |
| Refresh Date | 2015-11-10 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 50152 | CSP.0025002 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2008-03-01 - 2009-02-28 | INACTIVE |
| Street Address | 95169 DOUGLAS RD |
| City | FERNANDINA BEACH |
| State | FL |
| Zip Code | 32034-1268 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Dorothy L Simmons | 92043 Woodlawn Drive, Fernandina Beach, FL 32034 | Licensed Practical Nurse | 2019-10-01 ~ 2020-09-30 |
| Richard T Johnson | 85105 Champlain Drive, Fernandina Beach, FL 32034 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Tracy Ann Lynch · Blattel | 1295 S 4th Street, Fernandina Beach, FL 32034 | Hairdresser/cosmetician | 2020-04-01 ~ 2022-03-31 |
| Crystal M Gallagher · Morey | 33134 Sawgrass Parke Place, Fernadina Beach, FL 32034 | Registered Nurse | 2020-02-01 ~ 2021-01-31 |
| Teresa M Lavoie | 652 Fernandina Ct, Fernandina, FL 32034 | Registered Nurse | 2018-04-01 ~ 2019-03-31 |
| Ardith Y O'day | 36 Beachwalker Road, Amelia Island, FL 32034 | Registered Nurse | 2018-04-01 ~ 2019-03-31 |
| Leah M Campbell | 95290 Snapdragon Drive, Fernandina Beach, FL 32034 | Physical Therapist Assistant | 2019-08-01 ~ 2020-07-31 |
| Anne Monckton | 33126 Sunny Parke Circle, Fernandina Beach, FL 32034 | Licensed Practical Nurse | 2017-10-01 ~ 2018-09-30 |
| Marianne C Wallace | 16 Wild Grape Dr, Amelia Island, FL 32034 | Registered Nurse | 2017-01-01 ~ 2017-12-31 |
| Ann Schraff Keating · Peter J. Hastings | 30 Long Point Dr, Amelia Island, FL 32034 | Real Estate Salesperson | 2002-06-01 ~ 2003-05-31 |
| Find all Licenses in zip 32034 | |||
| City | FERNANDINA BEACH |
| Zip Code | 32034 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + FERNANDINA BEACH |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Taylor Merrick | 154 Conklin Rd, Stafford Springs, CT 06076-4207 | Physician Assistant | ~ |
| Alexandra Taylor Martin | 661 King Ave, Bronx, NY 10464-1114 | Physician Assistant | 2019-07-26 ~ 2020-04-30 |
| Taylor Bartini Kelley | 35 Jolley Dr Ste 301, Bloomfield, CT 06002-4228 | Physician Assistant | 2020-05-01 ~ 2021-04-30 |
| Rachael E Taylor | 8107 Goodfellow Ln, Mechanicsville, VA 23111-4680 | Physician Assistant | 2013-02-01 ~ 2014-01-31 |
| Allison E Taylor | 206 Camp Street, Middletown, CT 06457 | Physician Assistant | 1993-12-01 ~ 1994-04-30 |
| Demetrios Sotiropoulos | 41 Taylor Street, East Longmeadow, MA 01028 | Physician Assistant | 2018-04-01 ~ 2019-03-31 |
| Jessica Taylor Wilm | 3069 47th St, Astoria, NY 11103-1571 | Physician Assistant | 2019-09-09 ~ 2020-06-30 |
| Taylor M Lockrow | 243 Steele Road, West Hartford, CT 06117 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
| Susan Taylor Mcdiarmid | 10 Powder Mill Lane, North Granby, CT 06060 | Physician Assistant | 2020-06-01 ~ 2021-05-31 |
| Physician Assistant Foundation of The American Academy of Physician Assistants | 2318 Mill Rd Ste 1300, Alexandria, VA 22314-6868 | Public Charity | 2019-12-01 ~ 2020-11-30 |
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| 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).