Provider Demographics
NPI:1295507499
Name:CULOTTA, NICKY (AGACNP-BC, FNP-BC)
Entity type:Individual
Prefix:
First Name:NICKY
Middle Name:
Last Name:CULOTTA
Suffix:
Gender:M
Credentials:AGACNP-BC, FNP-BC
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:CULOTTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGACNP-BC, FNP-BC
Mailing Address - Street 1:552 KRISTIAN CT
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3716
Mailing Address - Country:US
Mailing Address - Phone:504-858-6335
Mailing Address - Fax:
Practice Address - Street 1:552 KRISTIAN CT
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-3716
Practice Address - Country:US
Practice Address - Phone:504-858-6335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP232356363LA2100X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily