Nicole Yacobino

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AL4405 Issued in FL

Practice address

Nem-008 BLDG M7-355 O&C 1108
Kennedy Space Center, FL 32899-2163

Phone

(321) 867-7497

NPI assigned

Apr 30, 2020

Last updated

Dec 10, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1588204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1285255224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8720 JASMINE CT",
            "city": "CAPE CANAVERAL",
            "state": "FL",
            "postal_code": "329202547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NEM-008 BLDG M7-355 O&C 1108",
            "city": "KENNEDY SPACE CENTER",
            "state": "FL",
            "postal_code": "328992163",
            "telephone_number": "321-867-7497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YACOBINO",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-30",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "24911",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL4405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOC",
            "identifier": "080702047",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "nicole.yacobio@parrishmed.com",
            "affiliation": "N",
            "address_1": "951 N Washington Ave",
            "city": "Titusville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327962163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mary Kathleen Kirkland, MS, ATC, LAT, CSCS
• Violette W Salib, M.D.
• Ian Christopher Stites, LAT, ATC
• Steven P. Taubkin, M.D.
• David Allen Tipton, M.D.

• Athletic Trainer in Kennedy Space Center, FL
• Providers in Kennedy Space Center, FL by specialty
• Athletic Trainer in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; 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.