Healthcare Provider Details

I. General information

NPI: 1780508291
Provider Name (Legal Business Name): NICHOLAS SETH POLOTZOLA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 NE EVANGELINE TRWY
CARENCRO LA
70520-5966
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-565-2675
  • Fax:
Mailing address:
  • Phone: 337-565-2675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number219616
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: