MEDICARE: TANYA LASHAWN ARNOLD CRANIAL PROSTHETIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management	C0134100	GA
2	224P00000X	Prosthetist	C0134100	GA

General Provider Information

NPI Number	:	1235773573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA LASHAWN ARNOLD CRANIAL PROSTHETIC

Provider Business Mailing Address
First Line	:	5922 SHINGLE CREEK RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33811-1997
Country	:	US
Telephone Number	:	813-808-3762
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 KINGSWAY RD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510-2507
Country	:	US
Telephone Number	:	813-808-3762
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	04/06/2026

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