MEDICARE: YOURCENAR DESTIN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	SP034504	PA

General Provider Information

NPI Number	:	1588516843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOURCENAR DESTIN NP

Provider Business Mailing Address
First Line	:	25 N LANSDOWNE AVE
Second Line	:
City	:	LANSDOWNE
State	:	PA
Zip	:	19050-2205
Country	:	US
Telephone Number	:	835-226-8516
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 N LANSDOWNE AVE
Second Line	:
City	:	LANSDOWNE
State	:	PA
Zip	:	19050-2205
Country	:	US
Telephone Number	:	835-226-8516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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Directions to “ YOURCENAR DESTIN NP” Practice Location

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