JASEN W GUNDERSEN MD (Credential# 905459) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is July 1, 2016. The license expiration date date is June 30, 2017. The license status is INACTIVE.
JASEN W GUNDERSEN MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.048370. The credential type is physician/surgeon. The effective date is July 1, 2016. The expiration date is June 30, 2017. The business address is 2760 Ne 48th St, Lighthouse Point, FL 33064-7114. The current status is inactive.
| Licensee Name | JASEN W GUNDERSEN MD |
| Credential ID | 905459 |
| Credential Number | 1.048370 |
| Credential Type | Physician/Surgeon |
| Business Address |
2760 Ne 48th St Lighthouse Point FL 33064-7114 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2010-01-07 |
| Effective Date | 2016-07-01 |
| Expiration Date | 2017-06-30 |
| Refresh Date | 2017-10-03 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 914003 | CSP.0047243 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2010-02-22 | 2015-03-01 - 2017-02-28 | INACTIVE |
| 862211 | 70.920052 | Emergency Medical Technician | 1991-12-12 | - 1996-01-01 | INACTIVE |
| Street Address | 2760 NE 48TH ST |
| City | LIGHTHOUSE POINT |
| State | FL |
| Zip Code | 33064-7114 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Elizabeth C Gundersen Md | 2760 Ne 48th St, Lighthouse Point, FL 33064-7114 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Kaitlin Ann Jones | 705 Nw 47th Street, Deerfield Beach, FL 33064 | Registered Nurse | 2020-06-01 ~ 2021-05-31 |
| Diane G Widak | 3362 Nw 11th Ave, Pompano Beach, FL 33064 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Eunice Roman | 4149 Ne 21st Terrace, Lighthouse Point, FL 33064 | Hairdresser/cosmetician | 2020-07-01 ~ 2022-06-30 |
| Nipponflex LLC | 3750 Park Central Blvd North, Pompano Beach, FL 33064 | Importer of Bedding & Upholstered Furniture | 2019-05-01 ~ 2020-04-30 |
| Dyno Seasonal Solutions LLC | 1571 W Copans Rd Ste#105, Pompano Beach, FL 33064 | Importer of Bedding & Upholstered Furniture | 2020-05-01 ~ 2021-04-30 |
| Amanda M Garcia | 4311 Crystal Lake Dr #318, Deerfield Beach, FL 33064 | Hairdresser/cosmetician | 2020-03-01 ~ 2022-02-28 |
| Anthony J Disimone | 2332 Ne 30th Court, Lighthouse Point, FL 33064 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Deborah A Dacus | 5110 Ne 29th Ave, Lighthouse Point, FL 33064 | Registered Nurse | 2018-09-01 ~ 2019-08-31 |
| Pamela A Flaherty | 2930 Ne 53rd Court, Lighthouse Point, FL 33064 | Registered Nurse | 2019-10-01 ~ 2020-09-30 |
| Oikia LLC | 1571 W Copans Rd Ste 101, Pompano Beach, FL 33064 | Manufacturer of Bedding & Upholstered Furniture | 2003-05-01 ~ 2004-04-30 |
| Find all Licenses in zip 33064 | |||
| City | LIGHTHOUSE POINT |
| Zip Code | 33064 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + LIGHTHOUSE POINT |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Ronald Gundersen · Gundersen Construction | 21 Walnut Terr, Naugatuck, CT 06770 | Home Improvement Contractor | 1998-12-01 ~ 1999-11-30 |
| Charles A Gundersen | 5 White Birch Bend, Portland, CT 06480 | Physician/surgeon | 2019-01-01 ~ 2019-12-31 |
| Dan Gundersen · Gundersen Quality Homes | 111 Laurelton Rd, Mount Kisco, NY 10549-4247 | Home Improvement Contractor | 2018-02-20 ~ 2018-11-30 |
| Glenn R Gundersen Co | 369 South Union St, Guilford, CT 06437 | Home Improvement Contractor | 2018-12-01 ~ 2019-11-30 |
| Jasen M Guluzzy | Naugatuck, CT 06770 | Pharmacy Technician | 2020-04-01 ~ 2021-03-31 |
| Jasen J Zarcone | 116 Brubaker Rd, Cheshire, CT 06410-3619 | Emergency Medical Technician | 2020-01-01 ~ 2022-12-31 |
| Jasen W Markette | 211 Spring St, Naugatuck, CT 06770-2990 | Emergency Medical Responder | 2017-09-13 ~ 2020-06-30 |
| Jasen Huggins | 50 Robertson Dr, Hamden, CT 06518 | Real Estate Salesperson | ~ |
| Jasen A. Clark | 251 Old Colchester Rd, Quaker Hill, CT 06375 | Crane Operator | 2020-04-03 ~ 2022-04-02 |
| Paula L Mccalla | 1780 Jasen Ave, N Valley Stream, NY 11580 | Physical Therapist | 1998-10-23 ~ 1999-10-31 |
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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).