MEDICARE: EXQUISITERX HEALTH

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1134087711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXQUISITERX HEALTH

Provider Business Mailing Address
First Line	:	3275 S JOHN YOUNG PKWY # 599
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-6556
Country	:	US
Telephone Number	:	321-246-2797
Fax Number	:	321-246-2797

Provider Business Practice Location Address
First Line	:	7362 FUTURES DRIVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819
Country	:	US
Telephone Number	:	321-246-2797
Fax Number	:	321-246-2797

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TYKEMA JOHNSON
Credential	:	APRN
Telephone Number	:	321-246-2797

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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Directions to “EXQUISITERX HEALTH ” Practice Location

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