MEDICARE: CARLY DAULTON AG-ACNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	95004713	CA

General Provider Information

NPI Number	:	1336694488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY DAULTON AG-ACNP

Provider Business Mailing Address
First Line	:	116 E YANONALI ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-1831
Country	:	US
Telephone Number	:	805-335-6972
Fax Number	:	805-519-7848

Provider Business Practice Location Address
First Line	:	116 E YANONALI ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-1831
Country	:	US
Telephone Number	:	805-335-6972
Fax Number	:	805-519-7848

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2016
Last Update Date	:	01/12/2026

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