Provider Demographics
NPI:1366012791
Name:TSAI, MERRICK MAYNARD (MD, FNP-BC, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:MERRICK
Middle Name:MAYNARD
Last Name:TSAI
Suffix:
Gender:M
Credentials:MD, FNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28839 LEMON ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5386
Mailing Address - Country:US
Mailing Address - Phone:909-742-9889
Mailing Address - Fax:
Practice Address - Street 1:28839 LEMON ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5386
Practice Address - Country:US
Practice Address - Phone:909-742-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV857119363LP0808X, 363LF0000X
AZ243315363LP0808X, 363LF0000X
CANP95017885363LP0808X, 363LF0000X
FLAPRN11020654363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily