| Entity Name: | THRIVEWELL LIFESTYLE MEDICINE, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 22 Feb 2024 (a year ago) |
| Document Number: | P24000027901 |
| Address: | 817 BAMA BREEZE DRIVE, DAYTONA BEACH, FL 32118 |
| Mail Address: | 817 BAMA BREEZE DRIVE, DAYTONA BEACH, FL 32118 |
| ZIP code: | 32118 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780407254 | 2024-11-04 | 2024-11-04 | 817 BAMA BREEZE DR, DAYTONA BEACH, FL, 321243799, US | 817 BAMA BREEZE DR, DAYTONA BEACH, FL, 321243799, US | |||||||||||||
|
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| Phone | +1 386-488-1449 |
Authorized person
| Name | GARY PITTS |
| Role | OWNER |
| Phone | 3864881449 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| SEABREEZE CORPORATE SERVICES, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| PITTS, GARY, MD | President | 817 BAMA BREEZE DRIVE, DAYTONA BEACH, FL 32124 |
| Name | Date |
|---|---|
| Domestic Profit | 2024-02-22 |
Date of last update: 08 Feb 2025
Sources: Florida Department of State
