DEREK P ELLIOTT SR (Credential# 743245) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is July 21, 2005. The license expiration date date is April 30, 2006. The license status is INACTIVE.
DEREK P ELLIOTT SR is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.001496. The credential type is physician assistant. The effective date is July 21, 2005. The expiration date is April 30, 2006. The business address is P.o. Box 162, West Groton, MA 01472. The current status is inactive.
| Licensee Name | DEREK P ELLIOTT SR |
| Credential ID | 743245 |
| Credential Number | 23.001496 |
| Credential Type | Physician Assistant |
| Business Address |
P.o. Box 162 West Groton MA 01472 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2004-07-23 |
| Effective Date | 2005-07-21 |
| Expiration Date | 2006-04-30 |
| Refresh Date | 2009-07-08 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 391123 | CSP.0036837 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2004-12-02 | 2005-03-01 - 2006-02-28 | INACTIVE |
| Street Address | P.O. Box 162 |
| City | West Groton |
| State | MA |
| Zip Code | 01472 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Nancy M Zajac | Po Box 344, West Groton, MA 01472 | Registered Nurse | 1993-06-24 ~ 1994-06-30 |
| City | West Groton |
| Zip Code | 01472 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + West Groton |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Elliott L Silverman Pa | 91 Bishop St Apt#32, New Haven, CT 06511 | Physician Assistant | 2006-07-26 ~ 2007-07-31 |
| Nancy R Elliott | Morse College, New Haven, CT 06520 | Physician Assistant | 1995-05-09 ~ 1996-05-31 |
| Elliott J Charrow | 15115 78th St, Howard Beach, NY 11414-1712 | Physician Assistant | 2016-05-01 ~ 2017-04-30 |
| Tina M St Onge | 80 Derek Dr, Tolland, CT 06084 | Occupational Therapist Assistant | 2019-08-01 ~ 2021-07-31 |
| Kaitlyn M St Onge | 80 Derek Dr, Tolland, CT 06084-2629 | Occupational Therapist Assistant | 2019-08-01 ~ 2021-07-31 |
| Margaret C Volpe | 6 Derek Ln, Windsor, CT 06095-1757 | Occupational Therapist Assistant | 2013-08-01 ~ 2015-07-31 |
| Derek J Kelliher | 181 Sherbrook Street #35, Bristol, CT 06010 | Occupational Therapist Assistant | 2019-08-01 ~ 2021-07-31 |
| Derek L Somerville | 25 Buckley Street, Port Jervis, NY 12771 | Occupational Therapist Assistant | 2008-05-23 ~ 2009-07-31 |
| Erica L Elliott | 739 East St, Southington, CT 06489-3872 | Occupational Therapist Assistant | 2019-08-01 ~ 2021-07-31 |
| 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 |
Please comment or provide details below to improve the information on DEREK P ELLIOTT SR.
| 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).