Healthcare Provider Details

I. General information

NPI: 1487519013
Provider Name (Legal Business Name): AARON THOMAS BLEVINS PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S FLORIDA AVE
LAKELAND FL
33803-3809
US

IV. Provider business mailing address

3123 CLEVELAND HEIGHTS BLVD
LAKELAND FL
33803-4516
US

V. Phone/Fax

Practice location:
  • Phone: 863-732-7200
  • Fax: 863-732-7201
Mailing address:
  • Phone: 863-732-7200
  • Fax: 863-732-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11043459
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: