Provider Demographics
NPI:1033934039
Name:DESTY, SHIRLEY (RN)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:DESTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 SW CABURN AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7667
Mailing Address - Country:US
Mailing Address - Phone:561-983-1263
Mailing Address - Fax:
Practice Address - Street 1:658 SW CABURN AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-7667
Practice Address - Country:US
Practice Address - Phone:561-983-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9532982163WH0200X, 163WS0121X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery