Individual
NICOLE YACOBINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
NEM-008 BLDG M7-355 O&C 1108, KENNEDY SPACE CENTER, FL 32899-2163
(321) 867-7497
Mailing address
8720 JASMINE CT, CAPE CANAVERAL, FL 32920-2547
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
24911
FL
2255A2300X
Athletic Trainer
Primary
AL4405
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080702047
BOC
—
Enumeration date
04/30/2020
Last updated
12/10/2021
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