Provider Demographics
NPI:1508741802
Name:THE MED SPA LLC
Entity type:Organization
Organization Name:THE MED SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-822-2088
Mailing Address - Street 1:9924 GULF COAST MAIN ST # A120
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-9026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9924 GULF COAST MAIN ST # A120
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-9026
Practice Address - Country:US
Practice Address - Phone:239-295-8767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty