Healthcare Provider Details

I. General information

NPI: 1578154530
Provider Name (Legal Business Name): JACQUELINE G GILBERT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MAIN ST
PLAINVILLE CT
06062-1944
US

IV. Provider business mailing address

276 HIGHLAND AVE STE A2
WATERBURY CT
06708-3022
US

V. Phone/Fax

Practice location:
  • Phone: 860-747-0411
  • Fax:
Mailing address:
  • Phone: 203-819-7220
  • Fax: 203-819-7270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9482
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9482
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: