Healthcare Provider Details

I. General information

NPI: 1114262722
Provider Name (Legal Business Name): ARKINA NIKKI TAYLOR CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626C ADMIRAL DR SUITE 748
ANNAPOLIS MD
21401-2151
US

IV. Provider business mailing address

626C ADMIRAL DR SUITE 748
ANNAPOLIS MD
21401-2151
US

V. Phone/Fax

Practice location:
  • Phone: 877-230-9617
  • Fax:
Mailing address:
  • Phone: 877-230-9617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number2645
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: