WILLIAM G BROADHURST (Credential# 742841) 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.
WILLIAM G BROADHURST is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.001092. The credential type is physician assistant. The effective date is May 1, 2020. The expiration date is April 30, 2021. The business address is 22 Crestview Dr, Brookfield, CT 06804-2414. The current status is active.
| Licensee Name | WILLIAM G BROADHURST |
| Credential ID | 742841 |
| Credential Number | 23.001092 |
| Credential Type | Physician Assistant |
| Business Address |
22 Crestview Dr Brookfield CT 06804-2414 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2001-08-01 |
| Effective Date | 2020-05-01 |
| Expiration Date | 2021-04-30 |
| Refresh Date | 2020-04-13 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 281420 | CSP.0031154 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2001-08-08 | 2019-03-01 - 2021-02-28 | ACTIVE |
| 751762 | 28.000970 | Radiographer | 1994-10-21 | 2010-05-01 - 2011-04-30 | INACTIVE |
| Street Address | 22 Crestview Dr |
| City | BROOKFIELD |
| State | CT |
| Zip Code | 06804-2414 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Holly J Broadhurst | 22 Crestview Dr, Brookfield, CT 06804-1230 | Radiographer | 2019-10-01 ~ 2020-09-30 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Antonio J Paz | 60 Old New Milford Rd Ste 3e, Brookfield, CT 06804-2414 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| Valdet Nikci | 60 Old New Milford Rd Ste 3e, Brookfield, CT 06804-2414 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Daniel N Fish | 60 Old New Milford Rd Ste 3e, Brookfield, CT 06804-2414 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Juan Liang | 6 Tara Dr, Brookfield, CT 06804 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Lenore A Fox · Castellano | 16 Johns Rd, Brookfield, CT 06804 | Respiratory Care Practitioner | 2020-08-01 ~ 2021-07-31 |
| Xuefang Chen | 13 Hillside Court, Brookfield, CT 06804 | Real Estate Salesperson | ~ |
| J Scott Williams | 30 Obtuse Road South, Brookfield, CT 06804 | Landscape Architect | 2020-08-01 ~ 2021-07-31 |
| Liudmila Yakauleva | 317 Federal Road Suite C, Brookfield, CT 06804 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Brandi L Hennessey | 24 Riverview Court, Brookfield, CT 06804 | Real Estate Salesperson | ~ |
| Medical Warehouse Inc | 72 Grays Bridge Rd, Brookfield, CT 06804 | Wholesaler of Drugs, Cosmetics & Medical Devices | 2020-07-01 ~ 2021-06-30 |
| Heather Lynn Edelmann | 87 Heatherwood Drive, Brookfield, CT 06804 | Notary Public Appointment | 2020-06-25 ~ 2025-06-30 |
| Xiaoming Zheng | 540 Federal Rd, Brookfield, Connecticut 06804, Brookfield, CT 06804 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Shop Rite | Federal Rd, Brookfield, CT 06804 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06804 | |||
| City | BROOKFIELD |
| Zip Code | 06804 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + BROOKFIELD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Broadhurst Manor | 1038 Old Post Road, Fairfield, CT 06430 | Community Living Arrangement | 2019-11-01 ~ 2021-10-31 |
| William B Gorsuch | 267 Melba St C-18, Milford, CT 06460 | Physician Assistant | 1997-08-25 ~ 1998-10-31 |
| William S Nicholson | 232 Nersesian Rd, Hartwick, NY 13348 | Physician Assistant | 2002-07-01 ~ 2003-05-31 |
| William J Keys | 64 Atwood Rd, Middlebury, CT 06762 | Physician Assistant | 1999-06-28 ~ 2000-08-31 |
| William S King | 17 Tumblebrook Cir, Somers, CT 06071 | Physician Assistant | 2019-09-01 ~ 2020-08-31 |
| William K. Shafto | 4 Flintlock Dr, Danbury, CT 06811 | Physician Assistant | 2020-05-01 ~ 2021-04-30 |
| William Reed | 209 Knollwood Ave, Mamaroneck, NY 10543 | Physician Assistant | 2020-01-01 ~ 2020-12-31 |
| William H Cullen IIi | 38 Zacks Way, Agawam, MA 01001-3246 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
| William Avery Pa | 120 Clark St, Milford, CT 06460 | Physician Assistant | 2007-07-19 ~ 2008-08-31 |
| William H Thorn | 12525 Fostoria Way, Gaithersburg, MD 20878 | Physician Assistant | 2019-12-01 ~ 2020-11-30 |
Please comment or provide details below to improve the information on WILLIAM G BROADHURST.
| 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).