Provider Demographics
NPI:1104625532
Name:HER AESTHETICS MEDICAL SPA LLC
Entity type:Organization
Organization Name:HER AESTHETICS MEDICAL SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ACCARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:985-662-8806
Mailing Address - Street 1:604 RUE CANNES
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-3610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 W MORRIS AVE STE B
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-4024
Practice Address - Country:US
Practice Address - Phone:985-662-8806
Practice Address - Fax:985-214-8232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center