Healthcare Provider Details

I. General information

NPI: 1033025580
Provider Name (Legal Business Name): THRIVE WELLNESS LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15375 LAUGHING GULL LN
BONITA SPRINGS FL
34135-8518
US

IV. Provider business mailing address

15375 LAUGHING GULL LN
BONITA SPRINGS FL
34135-8518
US

V. Phone/Fax

Practice location:
  • Phone: 239-671-0958
  • Fax:
Mailing address:
  • Phone: 239-319-8819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JANIS GLOVER
Title or Position: OWNER
Credential: APRN
Phone: 239-671-0958