Provider Demographics
NPI:1306631403
Name:HOLLRAH, CARLY (FNP)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:HOLLRAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BONFOUCA LN
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1642
Mailing Address - Country:US
Mailing Address - Phone:985-353-0394
Mailing Address - Fax:
Practice Address - Street 1:179 HIGHWAY 22 E UNIT 300
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-4202
Practice Address - Country:US
Practice Address - Phone:985-353-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA240310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily