Provider Demographics
NPI:1295344059
Name:WELLNESS WORKS MEDICAL GROUP LLC
Entity type:Organization
Organization Name:WELLNESS WORKS MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:703-678-7695
Mailing Address - Street 1:104 SE LONITA ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3447
Mailing Address - Country:US
Mailing Address - Phone:772-463-2344
Mailing Address - Fax:772-463-9565
Practice Address - Street 1:104 SE LONITA ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3447
Practice Address - Country:US
Practice Address - Phone:772-463-2344
Practice Address - Fax:772-463-9565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty