Medical Spa Requirements in Florida: Which Licenses You Need

Search for the Florida med spa license and you will not find it. Florida has no license by that name.

What a medical spa needs instead is a stack. The business holds a clinic license or fits an exemption, each person who treats patients holds a license that covers the treatment, and the facial room, the drug order and the city each bring a permit. If you are buying a med spa, the same stack is your due diligence checklist.

Florida has no med spa license, so the first question is the clinic license

The business license comes from the Health Care Clinic Act, Part X of chapter 400, Florida Statutes. A “clinic” is “an entity where health care services are provided to individuals and which tenders charges for reimbursement for such services” (s. 400.9905(4), Fla. Stat.). Each clinic location needs its own AHCA license (s. 400.991(1)(a), Fla. Stat.).

AHCA’s rule reads that definition through billing: an entity becomes a clinic when it does not qualify for an exemption, provides health care services to individuals, and bills third-party payers for those services (rule 59A-33.006(14), F.A.C.). A spa paid only by its patients stands in a different place from one that bills an insurer.

For a med spa, ownership usually decides the exemption. A practice providing services by physicians, directly supervised by them and wholly owned by them (or by a physician and the physician’s spouse, parent, child or sibling) is exempt under s. 400.9905(4)(f). So is a practice wholly owned by licensed practitioners in the professions listed in s. 400.9905(4)(g), a list that includes physicians and APRNs but not registered nurses or cosmetology licensees. A practitioner-owner may not supervise services beyond the scope of the practitioner’s own license.

An exempt spa may apply for a certificate of exemption, which lasts up to 2 years, is not transferable and requires the spa first to post a schedule of its cash prices (s. 400.9935(6), Fla. Stat.). A change that defeats the exemption means the spa must apply for a license (rule 59A-33.006(14), F.A.C.). Ownership itself is covered in whether a nurse practitioner or PA can own a med spa.

A licensed clinic must appoint a medical director, who must be a physician, or, only if the clinic provides no services under the physician practice acts (chapters 458, 459, 460 and 461), a clinic director. The director agrees in writing to accept legal responsibility for the clinic’s duties, including seeing that every practitioner keeps a current, active Florida license (ss. 400.9905(5) and 400.9935(1), Fla. Stat.). Knowingly owning or operating an unlicensed clinic that must be licensed is a third-degree felony (s. 400.9935(4)(a), Fla. Stat.).

Every treatment needs a licensee whose license covers it

Physicians and PAs. Physicians practice under chapters 458 and 459, and practicing medicine without a Florida license is a third-degree felony (s. 458.327(1)(a), Fla. Stat.). A PA performs services the supervising physician delegates, in line with the PA’s education and training, and a physician may supervise no more than 10 PAs at any one time (s. 458.347(3) and (4)(h)). The physician may delegate only tasks the physician is qualified by training or experience to perform (rule 64B8-30.012(1), F.A.C.), which matters when the supervising physician’s own practice is not aesthetic.

APRNs. An APRN works within an established protocol with a supervising physician, kept on site where the APRN practices (s. 464.012(3), Fla. Stat.). Autonomous APRN practice is limited to primary care practice, such as family medicine, general pediatrics and general internal medicine (s. 464.0123).

Registered nurses. Professional nursing includes administering medications and treatments “as prescribed or authorized by a duly licensed practitioner” (s. 464.003(19)(b), Fla. Stat.).

Estheticians. Florida has no license called “esthetician.” The credentials are a cosmetology license or a facial specialty registration, which requires 220 hours of training (s. 477.0201(1), Fla. Stat.). The Board of Cosmetology’s rule puts injections, laser and IPL treatments, ultrasound and HIFU, plasma pen, microneedling and FDA-approved medical devices beyond the scope of either credential (rule 61G5-18.00015, F.A.C.).

Laser hair removal. An electrologist may use laser and light-based devices for hair removal only with the required training and certification and under the direct supervision of a physician trained in hair removal (rule 64B8-56.002(2), F.A.C.). A physician may supervise no more than four electrologists at any one time (rule 64B8-56.002(6)).

Day-to-day roles are covered in medical spa supervision and staff roles, and injectables in the Botox and filler rules.

A satellite aesthetic office needs a dermatology or plastic surgery supervisor

When a physician supervises APRNs or PAs at an office other than the physician’s primary practice location, with no supervising physician on site, and the services there are primarily dermatologic or skin care services (including aesthetic skin care other than plastic surgery), s. 458.348(3)(c), Fla. Stat., requires all of the following:

• The physician is board certified or board eligible in dermatology or plastic surgery.
• The office is within 25 miles of the physician’s primary place of practice or in a contiguous county, and no two offices are more than 75 miles apart.
• The physician supervises only one office other than the primary place of practice.

Osteopathic physicians follow the same standards (s. 459.025). None of these standards applies to an office whose only service is laser hair removal by an APRN or PA (ss. 458.348(3)(e) and 459.025(3)(e)). The requirement falls on the supervising physician, not on the APRN or PA doing the injecting.

If you are opening a second location or replacing a medical director, have the licensing and supervision plan reviewed before you sign the lease. Schedule a confidential consultation

The facial room, the drug order and the city each need a permit

Salon license. Facials are a cosmetology specialty, and a place where a specialty is practiced is a specialty salon (s. 477.013(6) and (8), Fla. Stat.). No cosmetology salon or specialty salon may operate without a license from the Department of Business and Professional Regulation (DBPR) (s. 477.025(1)). Chapter 477 does not apply to physicians or registered nurses practicing within their professional duties (s. 477.0135(1)).

Electrology facility license. No electrology facility may operate without a facility license from the Department of Health (s. 478.51(1), Fla. Stat.).

Office surgery registration. An office where a physician performs liposuction removing more than 1,000 cubic centimeters of supernatant fat, or a Level II or Level III office surgery, must register with the Department of Health, which inspects it first (s. 458.328(1)(a), Fla. Stat.; s. 459.0138). Level II includes any surgery under moderate sedation (rule 64B8-9.009(4)(a), F.A.C.).

Drug permits. A health care business owned and operated by an entity with a federal employer tax identification number needs a health care clinic establishment permit from DBPR to purchase prescription drugs, and the permit names a qualifying practitioner responsible for them (s. 499.01(2)(r), Fla. Stat.). If the spa sends patients home with prescription products for a fee, the prescriber must register as a dispensing practitioner, who may not dispense Schedule II or Schedule III controlled substances outside narrow exceptions (s. 465.0276, Fla. Stat.).

DEA registration. Federal rules require a separate DEA registration for each principal place of business where controlled substances are dispensed (21 C.F.R. 1301.12(a)).

Local business tax receipt. Counties and cities may levy a local business tax (ss. 205.032 and 205.042, Fla. Stat.), and an applicant whose business is regulated by a state agency must first show the active state license (s. 205.194(1)).

A buyer should read the licensing stack as a due diligence checklist

When you buy a med spa, you buy its licensing position, and most of it does not come with the keys:

• Clinic license. For a licensed clinic, the seller must notify AHCA in writing at least 60 days before the change of ownership, and the buyer applies for its own license (s. 408.807, Fla. Stat.).
• Exemption. A certificate of exemption does not transfer (s. 400.9935(6), Fla. Stat.), and a practitioner-owned spa sold to an investor-owned buyer no longer fits s. 400.9905(4)(g).
• Salon and electrology licenses. Neither may be transferred from the name of the original licensee to another (ss. 477.025(7) and 478.51(10), Fla. Stat.).
• Drug permit. It is nontransferable, and a majority ownership change requires a new application before the date of the sale (s. 499.012(6), Fla. Stat.).
• DEA registration. A registration cannot be assigned or transferred without the DEA’s written consent (21 C.F.R. 1301.52(b)).
• People. Match every injector’s license to the menu and collect the signed APRN and electrologist protocols.

The deal itself is on the med spa purchase and sale page, and the order of steps for a new spa is in launching a medical spa in Florida.

Licensing is a stack, not a certificate

A Florida med spa is in order when every layer is in place at once: the clinic license or exemption, a licensee for each treatment, the required supervision, the salon and drug permits, and the local receipt. The menu, not the name on the door, decides which rules apply. If you are buying or opening a medical spa, have the licensing stack checked service by service before you commit. Schedule a confidential consultation

Frequently asked questions

Do you need a license to open a med spa in Florida?

Florida has no single med spa license. The business needs a health care clinic license from AHCA unless it falls outside the definition of a clinic or fits an exemption, such as ownership wholly by licensed practitioners in the listed professions. Each treatment needs a licensee whose license covers it, and facials and drug purchases need their own permits.

Can an esthetician do Botox or laser treatments in Florida?

Not under that credential. Florida licenses cosmetologists and facial specialty registrants, and the Board of Cosmetology’s rule puts injections, laser and IPL treatments, ultrasound, plasma pen and microneedling beyond their scope.

Does a Florida med spa need a board-certified doctor?

Yes, for a satellite aesthetic office. When APRNs or PAs provide primarily aesthetic services at an office without a supervising physician on site, that physician must be board certified or board eligible in dermatology or plastic surgery, and may supervise only one such office besides the primary practice. The rule does not apply to an office whose only service is laser hair removal.

Related reading

• Advertising and Marketing Regulations for Medical Spas in Florida
• Florida’s Infection Control Requirements for Medical Spas and Clinics
• Licensing and Regulation of Cosmetic Procedures in Florida
• Do You Need a Medical Director for Your Florida Medical Spa?

Practice area: Med Spa Attorney in Florida: Buying and Selling a Med Spa