Healthcare Provider Details

I. General information

NPI: 1366306763
Provider Name (Legal Business Name): LUXE MEDICAL SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 NE 26TH ST STE 102
WILTON MANORS FL
33305-1427
US

IV. Provider business mailing address

1881 NE 26TH ST STE 102
WILTON MANORS FL
33305-1427
US

V. Phone/Fax

Practice location:
  • Phone: 954-488-2256
  • Fax:
Mailing address:
  • Phone: 954-488-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARLINE BROWNLEE
Title or Position: AMBR
Credential: NP
Phone: 954-488-2256