How to Open a Nurse-Owned Practice in Maryland

You've done the math in your head more than once. A few injectable appointments on your day off, on your own schedule, in your own space, and suddenly the shifts you pick up out of obligation start to look optional. Maryland happens to be one of the highest-income states in the country, which in plain terms means the patients who'll happily pay out of pocket for tox and a vitamin drip are already in your zip code. (Already run your own practice? Skip ahead, there's a section below built specifically for you.)

The thing that stops most nurses in Maryland was never the clinical work. You already do harder things on a Tuesday than a first tox or IV appointment will ever ask of you. What stops people is everything around it, the ownership rules, the medical director, the setup, all sitting there as one giant undefined to-do. So let's take it in order, starting with the question every Maryland nurse asks first.

Can a nurse own an aesthetics, wellness, or functional health practice in Maryland?

Yes. Maryland has no statute preventing an unlicensed person, or a business owned by unlicensed individuals, from owning and operating a health care business. You form a standard LLC rather than a professional association, because only licensed individuals may own a Maryland P.A. The Maryland Attorney General addressed this directly: an unlicensed owner may operate a licensed-professional practice by contracting with licensed practitioners, just not organize that business as a professional corporation. (85 Op. Att'y Gen. 238 (2000); Md. Code, Corporations & Associations §4A-201 and §5-109.)

The Maryland rule that catches almost everybody

Your medical director's credential changes how your practice runs day to day, and most nurses guess it backwards.

If your medical director is an MD or DO, COMAR 10.32.09 applies. That rule requires the physician to personally perform the initial assessment of each patient and prepare a written treatment plan, and it says that cannot be delegated. It also requires the physician to be on site whenever a non-physician performs a cosmetic medical procedure. Maryland defines cosmetic medical procedure to include subcutaneous, intradermal, and intramuscular injections, meaning neuromodulators and dermal fillers, plus laser and intense pulsed light treatments and chemical peels. There is an "immediately available" exception instead of on-site, and it exists only for a physician assistant working under a delegation agreement. An RN is not eligible for it.

If your medical director is a certified registered nurse practitioner, none of that applies. Maryland grants CRNPs full practice authority under COMAR 10.27.07.03. A CRNP assesses, diagnoses, prescribes, and orders treatment independently, with no collaborative agreement, no physician supervision, and no on-site requirement. The Board of Physicians cosmetic rule is triggered by a physician's direction, not a CRNP's.

Most nurses assume an MD is the safer choice. In Maryland, it's the choice that puts someone else in your treatment room every time you inject.

One more that surprises people: a mobile or in-home IV model may require a Residential Service Agency license from the Office of Health Care Quality. It's fact-specific, and it's worth asking before you build a business around house calls.

How Five Square actually gets you started

The whole thing lives in one place: the free Five Square Nurses app. Your medical oversight, the step-by-step training, your pharmacy and vendor accounts, and the entire community of nurse business owners are all in there. You can open it between patients, on a lunch break, or on the couch at 9pm, and pick up right where you left off.

When you join, you're not handed a login and wished good luck. There's a Getting Started path that puts the order of operations right in front of you, so the mountain becomes a checklist.

You pick your lane, or combine them. Five Square supports three:

• Aesthetics. Tox and dermal filler, the core of a nurse-injector practice, with room to add more as you train.
• Wellness. IV therapy and vitamin injections. Low startup, very mobile-friendly, and a natural add-on to aesthetics.
• Functional Health. Peptides, lab work, and whole-person care for nurses who want longer-term, relationship-based patients.

You bring the nursing license and the nerve. We bring the medical director, the compliant Maryland setup, the training, member pricing on products, marketing help, and weekly live calls with experts and other nurse owners, so you're never stuck guessing alone.

And every Five Square member, brand new or already established, gets instant on-demand Good Faith Exams for $19.99 each, a price we subsidize because we believe in nurse success. A walk-in can be cleared in about a minute, seven days a week, and the exam paperwork lands right in the patient's chart, which is exactly what a state board wants to see.

You start before you feel ready, and that's the point

Most programs make you wait. Watch every module, sit through every call, and someday you finally see a patient. By then half the people who started have lost momentum. Five Square runs the other way: you start your practice while you're still finishing the training, because the training sticks when there's a real patient on next week's calendar.

Kayla, an ER nurse in North Carolina, had never injected anyone when she joined. She watched the videos, took notes, and set a goal of 30 people in 30 days. Here's the advice she'd give a nurse who's scared to start:

"Believe in yourself, even when you don't know how to do something. Figure it out. The clinical knowledge from your nursing career is more than enough to get started, and there's a community of people around you who want to help. Do it scared."
- Kayla, ER nurse

She launched April 4. Her first month: 46 appointments, 28 good-faith exams, and $10,320 in revenue, run out of a single room inside a salon she'd been a client at for years. That's one real month from one real nurse, not a typical result and not a promise, and your market and hours are your own. The point is she was exactly where you are, never-done-this-before, and she started anyway.

Does it actually work once you launch?

Getting launched is step one. What you really want to know is whether it works after that. Here's the honest picture, numbers included, because income claims in this industry deserve a skeptical read.

Results vary, and they depend on things no membership controls: your market, your hours, how long you've been at it, how consistently you market. As practices mature, some established members report months in the $10,000 to $20,000 range. Individual results vary widely. Some land higher, some lower, and nobody here will promise you a number.

What's more useful is the math underneath, which is public. Neurotoxin appointments bring in $200 to $600. A syringe of filler runs $500 to $800. IV sessions run $150 to $350. Functional health consults run $150 to $300, often with patients coming back monthly. At those prices, two to four appointments a month would cover the $899 membership before product costs, and everything past that is the business growing. Want to see it with your own pricing? Run your numbers in the Five Square membership earnings calculator.

The nurses say it better than a revenue range does:

"Five Square is the reason I was able to launch my career as an aesthetic nurse injector. From setting up my LLC and making sure I'm compliant in my state, to a dedicated medical director, weekly live calls with experts, and a huge network of nurse entrepreneurs, it was the best decision I made."
- Krystle N., 5-star Google review

"As a nurse, taking risks is not in our vocabulary. Five Square made me excited about starting my own business. Timely responses, professional, highly knowledgeable, and a team that wants to see me succeed. I say my risk was absolutely worth it."
- Patricia G., 5-star Google review

Inside the community, the wins show up in real time. A nurse a few weeks into her launch posted she was already up to eight bookings, nearly all of it from one post in a local mom's Facebook group. Another saw a husband and wife for their good-faith exams in under ten minutes using the same-day exam tool when her director wasn't free. Scroll the forum any week and it's full of small wins like these.

The Google rating sits at 4.8 stars, and the reviews keep naming the same things: the setup help, the medical director, the training, and a team that answers when you're stuck.

Already run a practice in Maryland? There's a membership for that too

Not every nurse reading this is starting from scratch. Plenty of you already run your own practice and already pay for a medical director somewhere. If that's you, a lot of what's above is stuff you sorted out a while ago, and Five Square has a leaner membership built for exactly your spot. In Maryland, it's actually how we're opening first.

It's called the Established Nurse Membership. It's $799 a month, month to month, no annual lock. You get a medical director who's actually engaged, a compliant structure in Maryland, vendor and product pricing, the Five Square Nurse Community, and those instant on-demand Good Faith Exams at $19.99 each, a price we subsidize for our members because we believe in nurse success. There's no new-injector training folded in, because you don't need it and shouldn't pay for it. If you ever want the full education stack later, you can add it.

Here's the honest pitch. Most established practices are either paying $1,500 to $5,000 a month for a director who's genuinely involved, or a few hundred for one who signs protocols and disappears, which is its own risk when a board comes asking. For most nurses, $799 all in beats both, on price and on what you actually get. Tell us what you're paying now and we'll show you the side by side. No pitch, just the math.

What it costs, and the catch nurses look for

For a nurse starting out, membership is a flat $899 a month for one tier, $1,199 for two, $1,499 for all three, on a 12-month term. Startup beyond that is lighter than people expect: a starter tox order, insurance that runs well under most nurses' guesses, and the products you actually use. No revenue share, ever. (Already have a practice? The Established Nurse Membership above is $799 a month, month to month.)

That's usually the moment the skeptical part of your brain asks where the catch is. Fair. So, plainly: you own your practice and your patients through your own LLC. Five Square does not take a cut of what you make, and if a discovery call turns up that the honest answer for you is 'not yet' or 'start smaller,' the team will tell you that too.

Maryland-specific costs to budget for

Forming the LLC runs $100 to file Articles of Organization with SDAT, plus $50 if you want it expedited, and there's a $300 annual report due every April 15 to stay in good standing. If you sell product to patients, Maryland taxes retail sales at 6% and you'll need a sales and use license plus a trader's license from the Clerk of the Circuit Court, scaled to the value of your retail inventory.

So, where do you actually start in Maryland?

You book the call. That's genuinely it. Not a six-month research project, a 15-minute conversation about your license, your goals, and what launching (or leveling up) in Maryland would look like for you. Whether you're brand new or already running a practice, the whole reason Five Square exists is so you're not doing the hard parts alone.

Schedule a discovery call

Common questions about starting a practice in Maryland

Does my medical director have to be in the building in Maryland?

It depends entirely on their credential. Under COMAR 10.32.09 an MD or DO directing cosmetic medical procedures has to be on site while a non-physician performs them. A CRNP medical director carries no on-site requirement, because that rule is triggered by a physician's direction. This is the single biggest operational difference in Maryland and it's worth deciding deliberately rather than by default.

Do I need a P.A. or a professional corporation in Maryland?

No. Only licensed individuals may own a Maryland professional corporation or professional association, so a standard LLC is the appropriate structure for a nurse-owned practice. You'll file Articles of Organization with SDAT, designate a resident agent with a Maryland street address, and calendar the April 15 annual report.

Can a registered nurse own a med spa in Maryland? Yes. Maryland lets a registered nurse own your practice directly, with a nurse practitioner as the remote medical director. It's one of the more straightforward states for it.

Do I need a medical director for aesthetics in Maryland? Yes. Maryland requires oversight for medical aesthetic services, and every Five Square practice includes a medical director as part of the membership.

Can a nurse do Botox in Maryland? Yes, within a compliant setup and with the oversight Maryland requires. The clinical work is rarely the question; it's whether the practice around it is built legally.

I already run a practice in Maryland. Can Five Square still help? Yes. The Established Nurse Membership is built for nurses who already have a practice: $799 a month, month to month, with a medical director, a compliant structure, vendor pricing, and $19.99 on-demand Good Faith Exams. No new-injector training you don't need, and no annual lock.

How much are Good Faith Exams? For Five Square members, simple Good Faith Exams are $19.99 each, on demand, seven days a week, a price we subsidize because we believe in nurse success. One exam can clear a patient for several treatments at once, and the documentation attaches right to the patient's chart.

Is Five Square available in Maryland yet? Five Square is expanding into Maryland, and in many new states the Established Nurse Membership opens first. The fastest way to get the timeline and hold your spot is a discovery call.

How much does it cost to start? For a new nurse, membership is $899 a month for one tier, and startup beyond that (a tox order, insurance, products) is lighter than most nurses expect. If you already run a practice, the Established Nurse Membership is $799 a month, month to month. No revenue share either way.