Provider Demographics
NPI:1992683403
Name:NARDONE, JACOB MICHAEL (LAT, ATC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:MICHAEL
Last Name:NARDONE
Suffix:
Gender:X
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-8404
Mailing Address - Country:US
Mailing Address - Phone:630-450-7352
Mailing Address - Fax:
Practice Address - Street 1:1220 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5092
Practice Address - Country:US
Practice Address - Phone:319-399-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1210072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer