Provider Demographics
NPI:1346301223
Name:YACOOB, CORVETTE V (ARNP)
Entity Type:Individual
Prefix:
First Name:CORVETTE
Middle Name:V
Last Name:YACOOB
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CORVETTE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7139 MARIPOSA CIR W
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-4646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1720
Practice Address - Country:US
Practice Address - Phone:954-431-1286
Practice Address - Fax:954-431-1239
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2104772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
306903600Medicare ID - Type Unspecified