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General NPI Number Information
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NPI Number | 1932919271
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Entity Type | Individual
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Provider Name | LUKE WILLIAM TACKENTIEN NP
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Gender | Male
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 15 S MAIN ST STE 110
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City | JAMESTOWN
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State | NY
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Zip | 14701-6626
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Country | US
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Telephone | 716-483-2320
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Fax | 716-484-2582
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Provider Business Mailing Address
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Address Line | 15 S MAIN ST STE 110
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City | JAMESTOWN
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State | NY
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Zip | 14701-6626
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Country | US
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Telephone | 716-483-2320
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Fax | 716-484-2582
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | F433158-01
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License Number State | NY
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