Healthcare Provider Details

I. General information

NPI: 1184534679
Provider Name (Legal Business Name): JOANNA TYUKAYENKO APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 S MCKINLEY ST
WASILLA AK
99654-8119
US

IV. Provider business mailing address

522 S MCKINLEY ST
WASILLA AK
99654-8119
US

V. Phone/Fax

Practice location:
  • Phone: 907-671-3797
  • Fax:
Mailing address:
  • Phone: 907-671-3797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number124748
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number258964
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: