By Anika Milian, Esq., Co-Founding Partner, B&M Law Group, PLLC · November 5, 2026
Short answer: no. In Florida, a nurse practitioner (APRN, still often called an ARNP) who is registered for "autonomous practice" can practice without a physician only in primary care. Botox, fillers and other aesthetic injectables are not primary care. To offer them, an APRN still needs a written protocol with a supervising Florida physician, even if the APRN is registered as autonomous.
This is one of the most common compliance mistakes we see in Florida medspas and wellness clinics. If you searched "do I need a supervising physician" or "can a nurse practitioner do Botox in Florida," this article is for you.
What "autonomous" APRN practice actually means in Florida
Since 2020, Florida law (section 464.0123, Florida Statutes) has let qualified APRNs register for autonomous practice. To qualify, an APRN must have at least 3,000 hours of physician-supervised clinical practice in the past five years, carry professional liability coverage of at least $100,000 per claim and $300,000 aggregate, and meet other requirements.
But the registration has a hard limit. An autonomous APRN may practice autonomously only in primary care, which the statute describes as family medicine, general pediatrics and general internal medicine, as defined by Board of Nursing rule. Autonomous APRNs also:
- may not perform surgical procedures other than subcutaneous procedures;
- must give new patients written information about their qualifications and the nature of autonomous practice; and
- must still follow a physician protocol for anything outside primary care.
Autonomous registration is not a license to practice everything independently. It is a license to practice primary care independently.
Why Botox and aesthetic injectables are not "primary care"
The Board of Nursing defines primary care around health promotion, disease prevention, and the diagnosis and treatment of acute and chronic illness. Cosmetic treatment of wrinkles does not fit that definition.
The Florida Association of Nurse Practitioners has explained the line this way: Botox for migraines in a primary care setting may be primary care, but Botox in a medspa for wrinkles is not, and requires a physician protocol. The same logic applies to dermal fillers, Kybella, PRP for aesthetics, lasers, microneedling with medical-grade devices and similar services.
Did anything change in 2026?
No. During the 2026 legislative session, bills to expand autonomous practice for psychiatric APRNs (HB 301 / SB 138) and for nurse anesthetists (HB 375) passed the House but died in the Senate on March 13, 2026. As of today, autonomous practice in Florida is still limited to primary care. None of those bills would have covered aesthetics anyway.
What you need to offer injectables as an APRN
If you are an APRN offering Botox, fillers or other aesthetic services, autonomous or not, you need:
- A written protocol with a Florida-licensed physician (sections 464.012 and 458.348). Florida law calls it a protocol; you may also hear "collaborative agreement" or "supervision agreement." The protocol should specifically cover the aesthetic procedures you perform, the drugs and devices involved, and how complications are handled.
- Notice of the protocol filed with the Board of Medicine by the supervising physician.
- Extra rules if the physician is not on site. If you work at an office that is not the physician's primary practice location, the physician is not on site, and the office mainly offers dermatologic or skin care services (which includes aesthetic skin care), Florida law also requires that:
- the physician is board certified or board eligible in dermatology or plastic surgery;
- the physician submits the office address to the Board;
- the office is within 25 miles of the physician's primary practice location or in a contiguous county, and never more than 75 miles away;
- the physician supervises only one such office besides the primary practice; and
- the office posts a schedule showing when the physician is there and the hours it is open while the physician is not.
Signs your medspa may be set up the wrong way
- "I'm autonomous, so I don't need a doctor for Botox."
- Your supervising physician is a family doctor or internist, the medspa is a satellite location, and they are rarely on site.
- Your "medical director" signed something once and you pay a monthly fee for the name.
- Your protocol does not mention injectables, or it expired with a physician who no longer works with you.
- Your supervising physician is "covering" several medspas at once.
- RNs or other staff are injecting based on their own judgment instead of a proper order from an authorized prescriber.
- No one has checked whether your business needs a health care clinic license.
If any of these sound familiar, it is fixable, but the fix should happen before a complaint, an adverse event or a Department of Health investigation.
Owning a medspa is not the same as practicing independently
Many APRNs own their medspa, and that is allowed. Florida's Health Care Clinic Act generally exempts practices wholly owned by licensed health care practitioners from the AHCA health care clinic license. If your business has non-practitioner owners, such as a spouse, an investor or an esthetician, you may need an AHCA license and a medical director appointed in writing.
But ownership answers who can own the business. It does not answer who can perform or authorize the treatment. An APRN who owns 100% of the medspa still needs a physician protocol to inject Botox.
What can happen if you get this wrong
Practicing outside the scope of your license can lead to Board of Nursing discipline, and the physician whose name is on a protocol they do not actually follow can face Board of Medicine discipline. It can also create problems with your malpractice insurance and leave your business exposed if a patient has a complication. These are avoidable risks.
How to fix it: a quick checklist
- List every service you offer and mark which are truly primary care.
- For everything else, put a written protocol in place with a properly qualified Florida physician.
- If your location is not the physician's primary office, confirm the dermatology or plastic surgery board status, the distance rules, the one-office limit and the posted schedule.
- Confirm the protocol notice was filed with the Board of Medicine.
- Confirm your ownership structure and whether you need an AHCA license or a certificate of exemption.
- Update your consents, delegation rules and staff training to match.
FAQ
Do I need a supervising physician as a nurse practitioner in Florida?
For primary care, not if you are registered for autonomous practice. For anything outside primary care, including Botox, fillers and other aesthetic services, yes. You need a written protocol with a Florida physician.
Can a nurse practitioner do Botox in Florida?
Yes, under a written protocol with a supervising physician. An APRN cannot do cosmetic Botox independently, even with autonomous registration.
Can an autonomous APRN open a medspa in Florida?
An APRN can own one. But owning the medspa does not make aesthetic services part of autonomous practice. A physician protocol is still required for those services.
What about IV therapy, weight loss and peptides?
These are gray areas. Whether a service counts as primary care depends on how it is actually delivered. A cash-pay wellness menu of IV drips, peptides or injectables is hard to defend as primary care. Get advice before relying on autonomous status for these services. For peptides specifically, see our guide to the 2026 HHS peptide policy for Florida medspas.
Is a collaborative agreement the same as a protocol in Florida?
In practice, yes. Florida law uses the word "protocol" for the written agreement between an APRN and a supervising physician. Whatever you call it, it has to meet the legal requirements and actually be followed. A "medical director" title on its own does not replace it.
How do I check if an APRN is registered for autonomous practice?
The Florida Department of Health license lookup identifies APRNs registered for autonomous practice on their practitioner profile.
Talk to a Florida medspa attorney
B&M Law Group helps Florida medspa and wellness owners set up their practices the right way: supervision structures and protocols, ownership and AHCA questions, consents and policies. We work in English and Spanish, throughout Florida. If you want a second look at your setup, you can book a consultation.
Sources: Fla. Stat. § 464.0123 · Fla. Stat. § 458.348 · Florida House analysis of HB 301 (2026) · HB 301 bill history · HB 375 bill history · Mondaq: primary care defined for autonomous APRNs