Ethereal Medspa LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

ETHEREAL MEDSPA LLC

Practice address

13011 SW 132ND St Ste B
Miami, FL 33186-7197

Phone

(786) 804-1241

NPI assigned

Mar 21, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Isabel M Gomez Hernandez, APRN

Title

Owner

Phone

(786) 804-1241

Specialties & licenses 1

Addresses

Tax ID family

Ethereal Medspa LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ethereal Medspa LLC

  • Primary Care Nurse Practitioner
  • Miami, FL
  • NPI 1841117611
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1742515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742515200000",
    "number": "1750182168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16894 SW 143RD PL",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331772755",
            "telephone_number": "786-804-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13011 SW 132ND ST STE B",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331867197",
            "telephone_number": "786-804-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHEREAL MEDSPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-21",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A",
        "authorized_official_last_name": "GOMEZ HERNANDEZ",
        "authorized_official_first_name": "ISABEL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-804-1241",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Miami, FL
• Providers in Miami, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.