# ETHEREAL MEDSPA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841117611
- **Authorized official:** ISABEL MARIA GOMEZ HERNANDEZ APRN (APRN)
- **Authorized official phone:** (786) 804-1241

## Contact information

- **Practice address:** 13011 SW 132ND ST, MIAMI, FL 33186-7197
- **Practice address phone:** (786) 804-1241
- **Mailing address:** 13011 SW 132ND ST, MIAMI, FL 33186-7197
- **Mailing address phone:** (786) 804-1241

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 07/02/2026
- **Last updated:** 07/14/2026