Healthcare Provider Details

I. General information

NPI: 1700966165
Provider Name (Legal Business Name): TONYA E KUKLA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 DUDALA CIR
LOUDON TN
37774-6817
US

IV. Provider business mailing address

532 DUDALA CIR
LOUDON TN
37774-6817
US

V. Phone/Fax

Practice location:
  • Phone: 706-832-1602
  • Fax:
Mailing address:
  • Phone: 706-832-1602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN122989
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number34522
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: