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General NPI Number Information
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NPI Number | 1922777606
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Entity Type | Organization
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Legal Business Name | EXCLUSIVE HEALTH CENTER, PLLC
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 8 MADEIRA DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-5343
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Country | US
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Telephone | 336-686-2346
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 N 6TH ST # 5078
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-1920
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Country | US
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Telephone | 904-552-4550
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ERICA EBOHON
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Credential | NP
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Telephone | 904-552-4550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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