=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134087711
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXQUISITERX HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2026
-----------------------------------------------------
Last Update Date | 01/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7362 FUTURES DRIVE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-246-2797
-----------------------------------------------------
Fax | 321-246-2797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3275 S JOHN YOUNG PKWY # 599
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34746-6556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-246-2797
-----------------------------------------------------
Fax | 321-246-2797
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. TYKEMA JOHNSON
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 321-246-2797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------