Healthcare Provider Details

I. General information

NPI: 1699839910
Provider Name (Legal Business Name): DIANE C LONGOBUCCO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

44 TWINING FARM LN
TORRINGTON CT
06790-7106
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-5414
  • Fax:
Mailing address:
  • Phone: 860-482-9897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number001153
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberE47415
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberE47415
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberE47415
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License NumberE47415
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: