# THRIVE MD WELLNESS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275358004
- **Authorized official:** MR. KEVIN STODDARD (MANAGER/OWNER)
- **Authorized official phone:** (904) 885-4635

## Contact information

- **Practice address:** 12724 GRAN BAY PKWY W STE 410, JACKSONVILLE, FL 32258-9486
- **Practice address phone:** (904) 659-3336
- **Practice address fax:** (904) 265-2465
- **Mailing address:** 12724 GRAN BAY PKWY W STE 410, JACKSONVILLE, FL 32258-9486
- **Mailing address phone:** (904) 659-3336
- **Mailing address fax:** (904) 265-2465

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133VN1201X | Obesity and Weight Management Nutrition Registered Dietitian | — | NULL | Yes |
| 133VN1201X | Obesity and Weight Management Nutrition Registered Dietitian | — | — | Yes |

## Other

- **Enumeration date:** 11/18/2024
- **Last updated:** 11/18/2024