Provider Demographics
NPI:1386621902
Name:LOOBY, GAYLE (APRN)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:LOOBY
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 1:30 JORDAN LN
Mailing Address - Street 2:PRIME HEALTHCARE
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1278
Mailing Address - Country:US
Mailing Address - Phone:860-263-0253
Mailing Address - Fax:860-263-0262
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:STE 3216 PRIME HEALTHCARE
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-247-2137
Practice Address - Fax:860-728-0480
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002531363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400002531CT01OtherBCBS
CT0002531OtherMEDICAL LICENSE
CT004219714Medicaid
CT004219714Medicaid
P42403Medicare UPIN
CT004219714Medicaid