MEDICARE: MARISSA SUNNEKALB FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1225151	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760164578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA SUNNEKALB FNP

Provider Business Mailing Address
First Line	:	1567 GOLIAD RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-2719
Country	:	US
Telephone Number	:	726-240-6950
Fax Number	:	210-761-3397

Provider Business Practice Location Address
First Line	:	1567 GOLIAD RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-2719
Country	:	US
Telephone Number	:	726-240-6950
Fax Number	:	210-761-3397

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	04/02/2026

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