Healthcare Provider Details

I. General information

NPI: 1952237562
Provider Name (Legal Business Name): SOFIA BEATRIZ SANDOVAL BS, DNP, CNL, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 PRAIRIE DR
MT PLEASANT WI
53406-4318
US

IV. Provider business mailing address

1311 PRAIRIE DR
MT PLEASANT WI
53406-4318
US

V. Phone/Fax

Practice location:
  • Phone: 787-455-0300
  • Fax:
Mailing address:
  • Phone: 787-455-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1857033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: