Healthcare Provider Details

I. General information

NPI: 1043970031
Provider Name (Legal Business Name): FOUR FRIENDS FITNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2021
Last Update Date: 12/18/2021
Certification Date: 12/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8106 OLD KINGS RD S STE 4
JACKSONVILLE FL
32217-5526
US

IV. Provider business mailing address

8106 OLD KINGS RD S STE 4
JACKSONVILLE FL
32217-5526
US

V. Phone/Fax

Practice location:
  • Phone: 904-586-2118
  • Fax:
Mailing address:
  • Phone: 904-586-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: TAKENYA LAMPKINS
Title or Position: OWNER
Credential:
Phone: 904-235-9429