Individual provider · Type 1 NPI

Tyler Kukla

Student in an Organized Health Care Education/Training Program · Fairfax, VA

NPI number 1003775958 Active

Practice location

8100 Innovation Park Dr Ste 110
Fairfax, VA 22031-4870

Call (703) 970-6427 Map

Mailing address

655 Promenade Apt 4016
Irving, TX 75039-1213

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1003775958

Tyler Kukla's National Provider Identifier is 1003775958, issued on Jan 16, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Fairfax, VA. The record was last updated on Jan 16, 2026.