Healthcare Provider Details

I. General information

NPI: 1962348144
Provider Name (Legal Business Name): DESTINY NORTH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENNETH WALTER JR.

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14492 HUMMINGBIRD RD
WEEKI WACHEE FL
34614-1468
US

IV. Provider business mailing address

14492 HUMMINGBIRD RD
WEEKI WACHEE FL
34614-1468
US

V. Phone/Fax

Practice location:
  • Phone: 727-294-2733
  • Fax:
Mailing address:
  • Phone: 727-294-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License NumberPN5264297
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: