Provider Demographics
NPI:1154697738
Name:KUYKENDALL, ANDREW TUCKER (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:TUCKER
Last Name:KUYKENDALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12901 BRUCE B DOWNS BLVD # 41
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4742
Mailing Address - Country:US
Mailing Address - Phone:813-259-0875
Mailing Address - Fax:813-259-8748
Practice Address - Street 1:12901 BRUCE B DOWNS BLVD # 41
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4742
Practice Address - Country:US
Practice Address - Phone:813-259-0875
Practice Address - Fax:813-259-8748
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME 120230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program