Thara L Guillory

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

26NJ15465900 Issued in NJ

Practice address

1300 Station Dr Apt 1303
Avenel, NJ 07001-1869

Phone

(386) 868-9658

NPI assigned

Oct 21, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Great Health Medical New Jersey PC

  • Family Medicine Physician
  • Lakewood, NJ
  • NPI 1417681008
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1761004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787616000000",
    "number": "1083581490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 STATION DR APT 1303",
            "city": "AVENEL",
            "state": "NJ",
            "postal_code": "070011869",
            "telephone_number": "386-868-9658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 STATION DR APT 1303",
            "city": "AVENEL",
            "state": "NJ",
            "postal_code": "070011869",
            "telephone_number": "386-868-9658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUILLORY",
        "first_name": "THARA",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-21",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "N10571",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "RN9573108",
            "primary": false
        },
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "FL",
            "license": "RN9573108",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NJ",
            "license": "26NJ15465900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Goldberg, D.D.S
• Yisel Gonzalez-Leonardo
• Madhavi Gottimukkula, D.M.D
• Gregory J. Shypula, MD, PA
• Diane Grossweiler, OT
• Sanjana Gulati, D.D.S
• Ashish Gupta, OTR/L
• Nidhi Nitin Gurjar
• Bishoy F Hanna, M.D.
• Alyssa Harrigane

• Gerontology Nurse Practitioner in Avenel, NJ
• Providers in Avenel, NJ by specialty
• Gerontology Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.