MEDICARE: MW WELLNESS XIII

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1033083258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MW WELLNESS XIII

Provider Business Mailing Address
First Line	:	2445 COUNTRY PLACE BLVD STE 101
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-1102
Country	:	US
Telephone Number	:	727-420-6986
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 COUNTRY PLACE BLVD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-1102
Country	:	US
Telephone Number	:	727-420-6986
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ OPERATOR
Name	:	NICOLE ILENE BALKCOM
Credential	:
Telephone Number	:	727-420-6986

Provider Enumeration Date	:	10/01/2025
Last Update Date	:	03/05/2026

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