Healthcare Provider Details

I. General information

NPI: 1295344059
Provider Name (Legal Business Name): WELLNESS WORKS MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 SE LONITA ST
STUART FL
34994-3447
US

IV. Provider business mailing address

104 SE LONITA ST
STUART FL
34994-3447
US

V. Phone/Fax

Practice location:
  • Phone: 772-463-2344
  • Fax: 772-463-9565
Mailing address:
  • Phone: 772-463-2344
  • Fax: 772-463-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NIDA RIZVI
Title or Position: PRESIDENT
Credential: APRN
Phone: 703-678-7695