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Individual
TINA E CHACKO
Active
Individual
TINA E CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA03879
TX
363AM0700X
Medical Physician Assistant
PA03879
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138512214
CSHCN
TX
01
—
8N5013
BCBS
TX
Enumeration date
07/05/2006
Last updated
10/30/2012
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