Provider Demographics
NPI:1700966165
Name:KUKLA, TONYA E (CRNA)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:E
Last Name:KUKLA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 DUDALA CIR
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-6817
Mailing Address - Country:US
Mailing Address - Phone:706-832-1602
Mailing Address - Fax:
Practice Address - Street 1:532 DUDALA CIR
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-6817
Practice Address - Country:US
Practice Address - Phone:706-832-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN122989367500000X
TN34522367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered