=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205794252
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOVA MD WELLNESS CLINIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2026
-----------------------------------------------------
Last Update Date | 01/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 148 EAST AVE STE 1G1
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06851-5727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-684-2050
-----------------------------------------------------
Fax | 203-941-1427
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 148 EAST AVE STE 1G1
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06851-5727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-684-2050
-----------------------------------------------------
Fax | 203-941-1427
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JASMINA KRSTIC
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 347-326-0623
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------