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General NPI Number Information
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NPI Number | 1649804089
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Entity Type | Individual
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Provider Name | FERNANDO SOSA III APRN
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Gender | Male
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 930 W RALPH HALL PKWY STE 108
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City | ROCKWALL
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State | TX
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Zip | 75032-6664
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Country | US
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Telephone | 972-961-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 CHISHOLM TRL
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-1220
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Country | US
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Telephone | 817-789-2467
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 33555
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License Number State | TX
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