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Background: Recent advances in biotechnology and nanomedicine have significantly transformed drug delivery strategies by enabling the development of engineered nanoparticles capable of improving therapeutic precision. Conventional pharmacological approaches often suffer from non-specific distribution, limited target-site accumulation, and substantial systemic toxicity, particularly in the treatment of complex disorders such as cancer, neurodegenerative diseases, and chronic inflammatory conditions. In this context, nanoparticle-based delivery systems have emerged as promising tools for enhancing drug stability, controlled release, and disease-specific targeting. Objective: This narrative review aimed to synthesize current evidence on emerging biotechnological strategies for precision drug delivery using engineered nanoparticles, with particular emphasis on targeted cellular interactions, ligand-mediated delivery, stimuli-responsive systems, biological barrier penetration, and translational challenges. Methods: A structured narrative review of recent peer-reviewed literature was undertaken using major scientific databases, including PubMed, Scopus, Web of Science, and Google Scholar. Relevant studies published in recent years were selected based on their contribution to nanoparticle engineering, targeting mechanisms, therapeutic applications, and translational significance. The evidence was synthesized thematically to provide an integrated overview of the current progress and limitations of biotechnology-driven nanoparticle systems. Results: The reviewed literature indicates that lipid-based, polymeric, ligand-functionalized, biomimetic, and stimuli-responsive nanoparticles offer substantial potential to improve therapeutic specificity, increase drug accumulation in diseased tissues, and reduce off-target toxicity. Targeted nanoparticle systems demonstrated enhanced cellular uptake and receptor-specific delivery, while smart nanoparticles enabled localized drug release in response to pathological microenvironmental triggers. Engineered nanoparticles also showed promise in overcoming biological barriers such as the blood–brain barrier. However, the overall evidence remains constrained by methodological heterogeneity, predominance of preclinical research, limited long-term safety data, manufacturing challenges, and insufficient large-scale clinical validation. Conclusion: Biotechnology-driven engineered nanoparticles represent a promising advancement in precision therapeutics with potential to improve the safety, specificity, and effectiveness of drug delivery. Nevertheless, further rigorous clinical studies, standardized evaluation frameworks, and interdisciplinary translational efforts are required before these technologies can be widely integrated into routine clinical practice.