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General NPI Number Information
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NPI Number | 1396659868
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Entity Type | Individual
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Provider Name | TANNER COLLIN KUKETZ EP
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Gender | Male
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 2223 S 48TH ST STE H
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City | TEMPE
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State | AZ
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Zip | 85282-1011
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Country | US
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Telephone | 863-338-0993
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Fax |
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Provider Business Mailing Address
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Address Line | 800 E CURRY RD APT 3021
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City | TEMPE
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State | AZ
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Zip | 85288-7057
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Country | US
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Telephone | 863-338-0993
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Y00000X
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Taxonomy Name | Clinical Exercise Physiologist
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License Number | 2000017
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License Number State | FL
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