<p>The Medjool date palm (<i>Phoenix dactylifera</i> L.) is the leading cultivar in Palestine due to its high market value, long shelf life, and tolerance to salinity. This study aimed to estimate the annual uptake of macronutrients (NPK) by Medjool date palms and compare nutrient inputs and removals based on tree productivity and pruning. Research was conducted during the 2023–2024 season on three farms in Jericho. Soil, irrigation water, and leaf samples were analyzed, and fertilizer applications and yields were recorded. The results show clear nutrient imbalances. Farmers applied on average 1,837 g Nitrogen (N), 376 g Phosphorus (P), and 11,706 g Potassium (K⁺) per tree annually, while estimated removal through yield and pruning was only 376 g N, 97 g P, and 580 g K⁺ per tree. Results were also evaluated against Food and Agriculture Organization (FAO) recommendations, which confirmed that Nitrogen (N) and potassium (K⁺) applications exceeded recommended levels by factors of 2.8 and 13.9, respectively, while phosphorus inputs were consistently below recommended thresholds. Substantial variation among farms reflected differences in management practices. These findings indicate inefficient fertilization strategies that result in N and K⁺ surpluses and P deficits. Such imbalances increase the risk of soil degradation, nutrient antagonism, and environmental loss while limiting productivity. Adoption of fertilization programs aligned with FAO guidelines, supported by soil, water, and plant testing, is essential to enhance nutrient use efficiency, sustain soil fertility, and ensure long-term Medjool date palm production in Palestine.</p>