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General NPI Number Information
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NPI Number | 1275358004
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Entity Type | Organization
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Legal Business Name | THRIVE MD WELLNESS, LLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 12724 GRAN BAY PKWY W STE 410
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City | JACKSONVILLE
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State | FL
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Zip | 32258-9486
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Country | US
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Telephone | 904-659-3336
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Fax | 904-265-2465
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Provider Business Mailing Address
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Address Line | 12724 GRAN BAY PKWY W STE 410
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City | JACKSONVILLE
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State | FL
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Zip | 32258-9486
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Country | US
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Telephone | 904-659-3336
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Fax | 904-265-2465
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | MR. KEVIN STODDARD
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Credential |
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Telephone | 904-885-4635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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