Provider Demographics
NPI:1932919271
Name:TACKENTIEN, LUKE WILLIAM (NP)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:WILLIAM
Last Name:TACKENTIEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6626
Mailing Address - Country:US
Mailing Address - Phone:716-483-2320
Mailing Address - Fax:716-484-2582
Practice Address - Street 1:15 S MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6626
Practice Address - Country:US
Practice Address - Phone:716-483-2320
Practice Address - Fax:716-484-2582
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF433158-01363LA2100X
NY433158363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care