Healthcare Provider Details

I. General information

NPI: 1922936053
Provider Name (Legal Business Name): DESTANY NEWBERN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4037 NW 86TH TER
GAINESVILLE FL
32606-9281
US

IV. Provider business mailing address

4000 NW 51ST ST APT B34
GAINESVILLE FL
32606-8304
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0820
  • Fax:
Mailing address:
  • Phone: 386-854-0698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11047451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: