Provider Demographics
NPI:1811238777
Name:MERRINER, ANNELISE (PA-C)
Entity type:Individual
Prefix:
First Name:ANNELISE
Middle Name:
Last Name:MERRINER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29472 AVENIDA DE LAS BANDERAS
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688
Mailing Address - Country:US
Mailing Address - Phone:949-459-9968
Mailing Address - Fax:949-766-2565
Practice Address - Street 1:29472 AVENIDA DE LAS BANDERAS
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688
Practice Address - Country:US
Practice Address - Phone:949-459-9968
Practice Address - Fax:949-766-2565
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA910712363A00000X
CA22953363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant