Provider Demographics
NPI:1528224425
Name:ORTIS, HOLLIE BRONSON (NP)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:BRONSON
Last Name:ORTIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 S SAINT ELIZABETH BLVD
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5021
Mailing Address - Country:US
Mailing Address - Phone:225-647-8511
Mailing Address - Fax:225-644-5213
Practice Address - Street 1:13489 HIGHWAY 431 STE A
Practice Address - Street 2:
Practice Address - City:SAINT AMANT
Practice Address - State:LA
Practice Address - Zip Code:70774-3213
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-644-2280
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1362824Medicaid
LA1362824Medicaid