Healthcare Provider Details

I. General information

NPI: 1851051833
Provider Name (Legal Business Name): AKINKAWON TAHIR FRIERSON LABORATORY DIRECTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2021
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2744 US 1 S
ST AUGUSTINE FL
32086-6366
US

IV. Provider business mailing address

2744 US HIGHWAY 1 S
ST AUGUSTINE FL
32086-6366
US

V. Phone/Fax

Practice location:
  • Phone: 888-890-1054
  • Fax: 904-600-4583
Mailing address:
  • Phone: 904-217-0479
  • Fax: 904-600-4583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: