Healthcare Provider Details

I. General information

NPI: 1174207435
Provider Name (Legal Business Name): JACQUELINE CARLTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E SANTA BARBARA ST STE A
SANTA PAULA CA
93060-2675
US

IV. Provider business mailing address

2600 VIRGINIA AVE NW STE 100
WASHINGTON DC
20037-1918
US

V. Phone/Fax

Practice location:
  • Phone: 805-525-2121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: