Provider Demographics
NPI:1336564533
Name:FORTIER, HOLLAN DESHOTEL (APRN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:HOLLAN
Middle Name:DESHOTEL
Last Name:FORTIER
Suffix:
Gender:F
Credentials:APRN, FNP-C
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Mailing Address - Street 1:401 YOUNGSVILLE HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5173
Mailing Address - Country:US
Mailing Address - Phone:337-330-0031
Mailing Address - Fax:337-330-0059
Practice Address - Street 1:1119 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT MARTINVILLE
Practice Address - State:LA
Practice Address - Zip Code:70582-3513
Practice Address - Country:US
Practice Address - Phone:337-394-7774
Practice Address - Fax:337-394-8015
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP07698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2359231Medicaid