Ethereal Medspa LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

ETHEREAL MEDSPA LLC

Practice address

13011 SW 132ND St
Miami, FL 33186-7197

Phone

(786) 804-1241

NPI assigned

Jul 2, 2026

Last updated

Jul 14, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Isabel Maria Gomez Hernandez, APRNNPI 1780401919

Title

Aprn

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

  • Family Nurse Practitioner
  • Miami, FL
  • NPI 1750182168
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Isabel Maria Gomez Hernandez, APRN

  • Family Nurse Practitioner
  • Cutler Bay, FL
  • NPI 1780401919
  Authorized official Same address or phone

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

{
    "created_epoch": "1782950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783987200000",
    "number": "1841117611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13011 SW 132ND ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331867197",
            "telephone_number": "786-804-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13011 SW 132ND ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331867197",
            "telephone_number": "786-804-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHEREAL MEDSPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-02",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A",
        "authorized_official_last_name": "GOMEZ HERNANDEZ",
        "authorized_official_first_name": "ISABEL",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "APRN",
        "authorized_official_telephone_number": "786-804-1241",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eternity Lives
• Eternity Medical Group Corp
• Eternity Medical Group Corp
• Eternity Medical Group Corp
• Ethereal Medspa LLC
• Ethos Behavioral Therapy LLC
• Ethan Etiel
• Yosef Etiel
• Jackson Etienne
• Jansie Etienne, ARNP

• Primary Care Nurse Practitioner in Miami, FL
• Providers in Miami, FL by specialty
• Primary Care Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2026; 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.