MEDICARE: ARKEYIA'S MEDICAL CROWN

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1841989365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARKEYIA'S MEDICAL CROWN

Provider Business Mailing Address
First Line	:	12220 ATLANTIC BLVD STE 130
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-5826
Country	:	US
Telephone Number	:	904-257-6560
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 BROOKWOOD FOREST BLVD APT 5208
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-9068
Country	:	US
Telephone Number	:	904-257-6560
Fax Number	:

Authorized Official
Title or Position	:	CRANIAL PROSTHESIS SPECIALIST
Name	:	TIFFANY ARKEYIA BURR
Credential	:
Telephone Number	:	904-258-7213

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	09/29/2023

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