Provider Demographics
NPI:1346955895
Name:COMPLEXION MEDICAL SPA PLLC
Entity Type:Organization
Organization Name:COMPLEXION MEDICAL SPA PLLC
Other - Org Name:COMPLEXION MED SPA AND AESTHETICS
Other - Org Type:Other Name
Authorized Official - Title/Position:DNP, FNP-BC
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:252-725-3844
Mailing Address - Street 1:201 W FORT MACON RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28512-5303
Mailing Address - Country:US
Mailing Address - Phone:252-773-0841
Mailing Address - Fax:252-773-0737
Practice Address - Street 1:201 W FORT MACON RD
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:NC
Practice Address - Zip Code:28512-5303
Practice Address - Country:US
Practice Address - Phone:252-773-0841
Practice Address - Fax:252-773-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty