Provider Demographics
NPI:1639856339
Name:TREVELYAN, CARLIE ANNE (PA)
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:ANNE
Last Name:TREVELYAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1327 STATE ST APT A
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2609
Mailing Address - Country:US
Mailing Address - Phone:480-620-8480
Mailing Address - Fax:
Practice Address - Street 1:2323 OAK PARK LN STE 202
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4276
Practice Address - Country:US
Practice Address - Phone:805-892-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2025-02-12
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant