Provider Demographics
NPI:1366119653
Name:LUKE, TATIYANA (APRN)
Entity type:Individual
Prefix:
First Name:TATIYANA
Middle Name:
Last Name:LUKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TATIYANA
Other - Middle Name:
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4001 KRESGE WAY STE 236
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:586 BRANNEN ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5557
Practice Address - Country:US
Practice Address - Phone:912-871-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016575363LF0000X
GAGAA-NP000384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily