Healthcare Provider Details

I. General information

NPI: 1306721980
Provider Name (Legal Business Name): LUKE KOTHE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 E TANQUE VERDE RD
TUCSON AZ
85715-5325
US

IV. Provider business mailing address

11401 E PANTANO TRL
TUCSON AZ
85730-5669
US

V. Phone/Fax

Practice location:
  • Phone: 520-222-5425
  • Fax:
Mailing address:
  • Phone: 402-208-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number229082
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: