Provider Demographics
NPI:1649511734
Name:CHACKO, JOSEPH (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:CHACKO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 DARWIN LN
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3456
Mailing Address - Country:US
Mailing Address - Phone:713-398-6514
Mailing Address - Fax:
Practice Address - Street 1:3378 FASHION SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2448
Practice Address - Country:US
Practice Address - Phone:989-272-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704262115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily