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General NPI Number Information
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NPI Number | 1972964476
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Entity Type | Individual
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Provider Name | JOSIPA KUKUCKA CRNA
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Gender | Female
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 1255 HIGHWAY 54 W
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4526
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Country | US
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Telephone | 770-719-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 BATES AVE
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City | HOUSTON
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State | TX
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Zip | 77030-2607
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Country | US
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Telephone | 137-981-3007
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN.1617919
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP129989
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License Number State | TX
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