Healthcare Provider Details

I. General information

NPI: 1124980123
Provider Name (Legal Business Name): EK GLOW WELLNESS & AESTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2025
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HERITAGE DR STE 210
JUPITER FL
33458-3097
US

IV. Provider business mailing address

600 HERITAGE DR STE 210
JUPITER FL
33458-3097
US

V. Phone/Fax

Practice location:
  • Phone: 561-316-6782
  • Fax:
Mailing address:
  • Phone: 561-316-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMARA LANGLEY
Title or Position: CEO, FOUNDER
Credential: DNP, FNP-BC
Phone: 561-316-6782