Provider Demographics
NPI:1871871970
Name:PHILACTOS, JOSEPH M (HAS, LPN)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:PHILACTOS
Suffix:
Gender:
Credentials:HAS, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43796 SPARROW DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33982-9413
Mailing Address - Country:US
Mailing Address - Phone:484-961-9961
Mailing Address - Fax:
Practice Address - Street 1:3434 HANCOCK BRIDGE PKWY STE 310-G
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-7094
Practice Address - Country:US
Practice Address - Phone:844-443-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPN287575164W00000X
PAF03596237700000X
FLAS5821237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No164W00000XNursing Service ProvidersLicensed Practical Nurse