Healthcare Provider Details

I. General information

NPI: 1437894862
Provider Name (Legal Business Name): ALEX NUCERINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BLACK AND GOLD BLVD
COLUMBUS OH
43211-2091
US

IV. Provider business mailing address

283 E 1ST AVE STE 105
COLUMBUS OH
43215-2184
US

V. Phone/Fax

Practice location:
  • Phone: 513-503-6744
  • Fax:
Mailing address:
  • Phone: 513-503-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT007114
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: