Healthcare Provider Details

I. General information

NPI: 1477796803
Provider Name (Legal Business Name): ERIN T MARIANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 EXECUTIVE LN STE 120
ROCKLEDGE FL
32955-3595
US

IV. Provider business mailing address

4500 NEWBERRY RD
GAINESVILLE FL
32607-2245
US

V. Phone/Fax

Practice location:
  • Phone: 321-639-2551
  • Fax:
Mailing address:
  • Phone: 352-332-0799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME125116
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME125116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: