Provider Demographics
NPI:1922777606
Name:EXCLUSIVE HEALTH CENTER, PLLC
Entity Type:Organization
Organization Name:EXCLUSIVE HEALTH CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBOHON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:904-552-4550
Mailing Address - Street 1:2800 N 6TH ST # 5078
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1920
Mailing Address - Country:US
Mailing Address - Phone:904-552-4550
Mailing Address - Fax:
Practice Address - Street 1:8 MADEIRA DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-5343
Practice Address - Country:US
Practice Address - Phone:336-686-2346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty