Can a Nurse Practitioner Own a Med Spa in California? AB-890 Explained (2026)

For years, nurse practitioners in California could only run a med spa with a physician partner. AB-890 changed that — but not for all NPs. Only a specific subset of nurse practitioners, called 104 NPs, gained independent practice rights starting January 1, 2026. Most NPs don't qualify yet.

Here's exactly what AB-890 means, who qualifies, and what qualifying gives you.

What Is AB-890?

California Assembly Bill 890, signed into law in 2020, created a phased pathway for qualified NPs to practice without physician supervision. The law recognized that requiring physician oversight for all NP practice was limiting access to care in underserved areas — and that experienced NPs with advanced training were capable of independent practice.

AB-890 was designed not as a blanket license for all NPs, but as a structured pathway requiring demonstrated experience. The legislature built in a two-step progression to ensure NPs seeking independent practice first proved themselves within a supervised setting before operating on their own.

The law was implemented in phases: the 103 NP designation — allowing practice in a group setting that includes a physician — became available in 2023. The 104 NP designation, which permits fully independent practice without any physician involvement, became available for the first time in January 2026.

The result is a system where independence is earned, not granted automatically. NPs who have been practicing since 2023 as 103 NPs are now the first cohort eligible to apply for 104 designation in 2026 — making this year the first time any California med spa can be legally owned and directed by an NP without a physician.

The Two AB-890 Pathways

AB-890 created two distinct NP practice designations. They are not interchangeable — the differences for med spa ownership are significant.

A 103 NP can practice in California without a formal collaborative practice agreement, but must still work within a group setting that includes at least one physician. For med spa purposes, this means a 103 NP can perform procedures and see patients, but cannot be the sole medical director of the facility.

A 104 NP has full independent practice authority. They can own a Professional Corporation, serve as the sole medical director, and operate a med spa with no physician involvement required at all. This is the designation that truly changes what an NP-owned med spa looks like in California.

What a 104 NP Can Do in a Med Spa

A qualifying 104 NP gains substantial authority to operate a med spa as a true independent owner and director. Specifically, a 104 NP can:

• Own a Professional Corporation as the sole physician-equivalent owner
• Serve as medical director without a supervising physician
• Independently prescribe medications and administer treatments within their scope
• Enter into a Medical Director Agreement with a med spa as the sole director

However, independence is not unlimited. The 104 NP must stay within the population focus of their national NP certification. An FNP (Family Nurse Practitioner) can treat adult cosmetic patients across the age spectrum. An AGNP (Adult-Gerontology NP) can treat adult and geriatric patients. A Pediatric NP cannot serve the typical adult cosmetic med spa patient population. A Psychiatric-Mental Health NP cannot perform cosmetic procedures — their certification's population focus is mental health, not aesthetics.

For a full breakdown of what the medical director role requires in California, see our guide to California med spa medical director requirements.

What a 104 NP Still Cannot Do

Independent practice does not mean unconstrained practice. AB-890 removes the requirement for a supervising physician — it doesn't change any other regulatory requirement. Even as a 104 NP, you must:

• Operate through a Professional Corporation — the Corporate Practice of Medicine doctrine still applies in California. The med spa's medical services must be rendered through a properly structured PC, with the 104 NP as the qualifying owner.
• Follow California advertising rules — California requires the supervising provider's name to appear in promotional materials. As a 104 NP and medical director, your name must be included.
• Maintain written treatment protocols — all procedures must be covered by written SOPs approved at the practice level. The absence of a physician doesn't eliminate this requirement; it transfers it entirely to you.
• Operate within your national certification's population scope — your 104 NP independence is bounded by your NP certification's defined patient population, not all of medicine.

The practical implication: a 104 NP med spa still needs comprehensive, well-documented clinical protocols for every procedure offered. The regulatory infrastructure doesn't disappear — ownership of it simply transfers from a physician to you.

What a 103 NP Can Do in a Med Spa

A 103 NP can work in a California med spa and perform procedures within their licensure scope — including injectables and laser treatments under appropriate conditions. The 103 NP designation eliminates the need for a formal written collaborative practice agreement and provides significantly more autonomy than a standard NP arrangement.

The key requirement is that a 103 NP must practice within a group setting that includes at least one physician. They cannot be the sole medical director of a med spa. The physician in the group setting provides the oversight structure that the 103 NP's independent practice requires.

For NPs on the path to 104 status, operating as a 103 NP in a group med spa setting is an excellent way to build the required 3 years of experience before applying for 104 designation. This period also builds the clinical practice management skills — protocol writing, compliance oversight, staff supervision — that become entirely your responsibility as a 104 NP.

Does This Apply to All Nurses?

This is the most common misconception about AB-890: the law applies only to licensed Nurse Practitioners (NPs) — specifically those who meet the experience and application requirements for 103 or 104 designation. It does not apply to other nursing credentials.

AB-890 does NOT apply to:

• Registered Nurses (RNs) — no matter how experienced or specialized
• Licensed Vocational Nurses (LVNs)
• Certified Registered Nurse Anesthetists (CRNAs) in a general med spa context
• Any other nursing credential not specifically designated as an NP with a national NP certification

An RN, no matter how many years of experience they have or how many procedures they have performed, cannot own or direct a California med spa under AB-890. The law is specifically for Nurse Practitioners who hold a recognized national NP certification (FNP, AGNP, PNP, WHNP, PMHNP, or similar) and who have completed the California Board of Registered Nursing's designation process.

If you hold an RN license and want to own a med spa, you still need either a physician medical director or to pursue NP licensure and then the 103/104 pathway — which takes a minimum of 6 years from initial 103 NP practice start to 104 NP designation.

Steps to Become a 104 NP in California

1. Hold an active California NP license with a national NP certification (FNP, AGNP, etc.) — this is your baseline credential.
2. Practice in California for at least 3 years or 4,600 hours to meet the experience threshold for 103 NP status.
3. Apply to the California Board of Registered Nursing for 103 NP designation — submit documentation of your experience, national certification, and California NP licensure.
4. Practice as a 103 NP in a group setting with a physician for at least 3 years — this period counts toward your 104 NP eligibility.
5. Apply to the California Board of Registered Nursing for 104 NP designation — submit documentation of your 3 years of 103 NP practice.
6. Upon receiving 104 NP designation, you can own and operate a med spa as the sole medical director, without any physician requirement.

The BRN Application Process for 103 and 104 NP Designation

Both the 103 NP and 104 NP designations are issued by the California Board of Registered Nursing (BRN), not the Medical Board of California. The BRN has published application requirements, but the specific process and required documentation have evolved since AB-890 was implemented — always confirm current requirements directly with the BRN before submitting.

For 103 NP designation, the BRN generally requires: proof of current California NP licensure in good standing, documentation of experience meeting the 3-year/4,600-hour threshold, verification of your national NP certification (ANCC or AANP), and a signed attestation of completion of the required transitional supervision experience.

For 104 NP designation, the BRN requires documentation of at least 3 years of practice as a 103 NP in California — not 3 years of general NP practice. The 3-year clock starts when you received your 103 NP designation, not when you finished NP school or started practicing in another state.

Processing times at the BRN have varied. If you're planning to open a med spa around the time you expect to receive 104 designation, don't schedule your opening date before the designation is in hand. Operating as a 104 NP-owned med spa before you've received the designation is a violation — regardless of how experienced you are.

Current BRN information, application forms, and processing updates are available at rn.ca.gov — Nurse Practitioner Practice.

Scope Limitations in Practice: What This Means for Cosmetic Med Spas

The 104 NP's independent authority is bounded by the population focus of their national NP certification. For a cosmetic med spa, the two relevant certifications are:

• Family Nurse Practitioner (FNP) — covers patients of all ages across the lifespan. An FNP can treat adult cosmetic patients, including the typical 25–65 age range that makes up most med spa clientele. This is the most flexible certification for a cosmetic med spa.
• Adult-Gerontology Nurse Practitioner (AGNP) — covers adult and geriatric patients (typically 18+). Appropriate for most cosmetic med spa patients but cannot extend to younger patients the way an FNP designation might.

The following certifications create scope problems for a cosmetic med spa:

• Pediatric NP (PNP) — practice scope is children and adolescents; cannot treat the adult cosmetic patient population
• Psychiatric-Mental Health NP (PMHNP) — scope is mental health treatment; cosmetic procedures fall outside the certification's defined scope
• Women's Health NP (WHNP) — focused on gynecology and women's reproductive health; cosmetic procedures are outside this scope
• Neonatal NP (NNP) — scope is newborns and critically ill neonates; not applicable to a cosmetic med spa

The scope limitation also affects your liability coverage. If a malpractice event arises from a procedure outside your certification's population scope, your insurer may deny coverage. Before opening, confirm with your malpractice carrier that your specific procedures and patient population are within your policy's scope.

104 NP vs. Physician Partner: Which Path Is Right for You?

Not every NP wanting to own a California med spa should wait for 104 NP designation. The right approach depends on your timeline, your current designation status, and your financial situation.

When to Pursue 104 NP Status

If you already have your 103 NP designation and are within 1–2 years of qualifying for 104 status, it may be worth waiting. Operating as a 104 NP gives you complete control over your practice — no physician to compensate, no shared authority, no risk that your physician partner leaves. For NPs who have built the clinical skills and want full ownership autonomy, the 104 path is the cleanest structure.

When to Open With a Physician Partner

If you're earlier in the AB-890 pathway — a standard NP just beginning the 103 NP process, or an NP who has 103 designation but won't qualify for 104 for several more years — opening with a physician as the controlling owner may be the better near-term path. The med spa operates legally, you gain business experience and build the patient base, and you can restructure to NP sole ownership if and when you qualify for 104 status.

A physician partner also adds credibility and referral network value in some markets. For a new med spa with no reputation yet, a physician's name on the practice can increase patient trust and enable a broader referral network — particularly for complex cases or patients referred by dermatologists and plastic surgeons.

Financial Consideration

A physician medical director costs $2,000–$6,000 per month in California. Over 3 years (the time it takes a 103 NP to reach 104 eligibility), that's $72,000–$216,000 in medical director fees. A 104 NP who waits avoids this cost. An NP who opens earlier with a physician partner starts generating revenue sooner and may recoup more than the director fees in the additional years of operation. Run the numbers for your specific market and timeline before deciding.

Common Mistakes NPs Make With AB-890

Assuming Standard NP Experience Counts Toward 103 Status

The 3-year experience threshold for 103 NP designation requires California experience — not total NP experience. An NP who practiced for 10 years in Texas before moving to California cannot count those years. Experience must be in California and must meet the Board's documentation requirements.

Assuming 103 NP Designation = Independent Ownership

A 103 NP can practice with more autonomy, but cannot own a med spa independently. Some NPs obtain their 103 designation and immediately assume they can open a med spa without a physician. They cannot. Independence requires the 104 designation — which requires 3 additional years as a 103 NP.

Practicing Outside Certification Scope

An NP with a Psychiatric-Mental Health certification who performs Botox injections is practicing outside their AB-890 scope — even with a 104 NP designation. The certification defines the patient population and scope of care. Aesthetic procedures performed by a PMHNP cannot be defended under AB-890 independent practice authority.

Opening Before Receiving Written Designation

The NP applied for 104 designation and is confident it will be approved. They open the med spa without a physician while waiting for the official designation. This is a violation — the independent practice authority comes from the designation itself, not from the eligibility to apply for it. Wait for written confirmation from the BRN before operating as a 104 NP owner-director.

Summary: AB-890 and California Med Spa Ownership for NPs

• AB-890 created two NP practice tiers: 103 NP (group practice with physician) and 104 NP (fully independent)
• Only licensed Nurse Practitioners with national NP certifications qualify; AB-890 does not apply to RNs, LVNs, or other nursing credentials
• 104 NP designation requires 3 years as a 103 NP in California — it became available for the first time in January 2026
• A 104 NP can own a Professional Corporation and serve as sole medical director without any physician
• The 104 NP's independent authority is bounded by their national certification's population scope — FNP or AGNP are the appropriate certifications for a cosmetic med spa
• All other California med spa requirements still apply: Professional Corporation structure, Medical Board registration, written protocols, HIPAA compliance, and advertising rules
• NPs who qualify for 104 status in the future should compare the financial math of opening with a physician partner now vs. waiting for independent designation

This article is for informational purposes only and does not constitute legal or medical advice. AB-890 implementation details and BRN application requirements may change. Consult the California Board of Registered Nursing and a California healthcare attorney before making ownership or practice structure decisions.

Frequently Asked Questions