Healthcare Provider Details

I. General information

NPI: 1174157713
Provider Name (Legal Business Name): LAURA J SANSONETTI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2020
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 GATEWAY PL FL 5
SAN JOSE CA
95110-3709
US

IV. Provider business mailing address

9191 KYSER WAY STE 205
FRISCO TX
75033-2783
US

V. Phone/Fax

Practice location:
  • Phone: 657-500-0634
  • Fax: 844-705-0129
Mailing address:
  • Phone: 972-643-8727
  • Fax: 972-643-8728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142516
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAP142516
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP142516
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: