Provider Demographics
NPI:1578154530
Name:GILBERT, JACQUELINE G (APRN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:G
Last Name:GILBERT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 HIGHLAND AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3022
Mailing Address - Country:US
Mailing Address - Phone:203-819-7220
Mailing Address - Fax:203-819-7270
Practice Address - Street 1:276 HIGHLAND AVE STE A2
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3022
Practice Address - Country:US
Practice Address - Phone:203-819-7220
Practice Address - Fax:203-819-7270
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9482363LG0600X, 363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health