Provider Demographics
NPI:1861364689
Name:BLUNT, ELEXIS MONIQUE
Entity type:Individual
Prefix:
First Name:ELEXIS
Middle Name:MONIQUE
Last Name:BLUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13423 121ST ST
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-1022
Mailing Address - Country:US
Mailing Address - Phone:727-269-6234
Mailing Address - Fax:
Practice Address - Street 1:13423 121ST ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-1022
Practice Address - Country:US
Practice Address - Phone:727-269-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372600000X, 385HR2060X, 385HR2065X, 3747A0650X, 3747P1801X
113879376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376K00000XNursing Service Related ProvidersNurse's Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant