Healthcare Provider Details

I. General information

NPI: 1568287563
Provider Name (Legal Business Name): DESTY NATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 SW CABURN AVE
PORT ST LUCIE FL
34953-7667
US

IV. Provider business mailing address

658 SW CABURN AVE
PORT ST LUCIE FL
34953-7667
US

V. Phone/Fax

Practice location:
  • Phone: 561-983-1263
  • Fax:
Mailing address:
  • Phone: 561-983-1263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY DESTY
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 561-983-1263