Healthcare Provider Details

I. General information

NPI: 1912305707
Provider Name (Legal Business Name): SERGIO A. SOSA JR. APN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3752 W 16TH ST
CHICAGO IL
60623-2028
US

IV. Provider business mailing address

3752 W 16TH ST
CHICAGO IL
60623-2028
US

V. Phone/Fax

Practice location:
  • Phone: 773-762-2435
  • Fax:
Mailing address:
  • Phone: 773-762-2435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209012266
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.012266
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: