Healthcare Provider Details

I. General information

NPI: 1013303551
Provider Name (Legal Business Name): MARIATU A VERLA MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIATU COLE MD

II. Dates (important events)

Enumeration Date: 04/11/2015
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BUDINGER AVE STE 206
SAINT CLOUD FL
34769-4123
US

IV. Provider business mailing address

1330 BUDINGER AVE STE 206
SAINT CLOUD FL
34769-4123
US

V. Phone/Fax

Practice location:
  • Phone: 407-498-3763
  • Fax: 407-498-3793
Mailing address:
  • Phone: 407-498-3763
  • Fax: 407-498-3793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberR5949
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME157946
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: