=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164319349
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW WAY MED SPA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2025
-----------------------------------------------------
Last Update Date | 09/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 312 THOMAS DR
-----------------------------------------------------
City | PANAMA CITY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32408-4902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-775-4498
-----------------------------------------------------
Fax | 850-775-4247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 312 NAVY BLVD
-----------------------------------------------------
City | PANAMA CITY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32408-4902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-775-4498
-----------------------------------------------------
Fax | 850-775-4247
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAREN TAYES
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 850-775-4498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------