Connect Wellness PLLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

CONNECT WELLNESS PLLC

Practice address

2416 E Washington St Ste G
Bloomington, IL 61704-1612

Phone

(309) 261-1102

NPI assigned

Apr 15, 2024

Last updated

Apr 17, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Gibb, APN, FNP-BC, PMHNPNPI 1770989220

Title

Aprn, Owner, Director

Phone

(309) 261-1102

Specialties & licenses 3

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Gibb, APN

  • Nurse Practitioner
  • Bloomington, IL
  • NPI 1770989220
  NPD Authorized official
• Matthew William Porzel, LCPC

  • Mental Health Counselor
  • Bloomington, IL
  • NPI 1821619545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1427802545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2506 KAITLYN DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043487",
            "telephone_number": "309-261-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2416 E WASHINGTON ST STE G",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617041612",
            "telephone_number": "309-261-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECT WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-15",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "GIBB",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "APRN, OWNER, DIRECTOR",
        "authorized_official_telephone_number": "309-261-1102",
        "authorized_official_credential": "APN, FNP-BC, PMHNP"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Connection Psychiatry, PLLC
• John Connolly, RPT
• Abby L Conrad, OTR
• Dean Constantopalos

• Primary Care Nurse Practitioner in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Primary Care Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.