Tara Cherrelle Gilliam, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

311842 Issued in NY

Practice address

101 Hospital Rd
Patchogue, NY 11772-4870

Phone

(631) 654-7100

NPI assigned

Aug 26, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: tgilliam505894@nyumc.direct-ci.com

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

{
    "created_epoch": "1724630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1487487302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 MARK TREE RD",
            "city": "CENTEREACH",
            "state": "NY",
            "postal_code": "117202238",
            "telephone_number": "631-740-7774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 HOSPITAL RD",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117724870",
            "telephone_number": "631-654-7100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "158 Mark Tree Rd",
            "address_purpose": "LOCATION",
            "city": "Centereach",
            "state": "NY",
            "postal_code": "117202238",
            "country_code": "US",
            "telephone_number": "631-740-7774",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLIAM",
        "first_name": "TARA",
        "middle_name": "CHERRELLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-26",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "311842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Giovanny Fernando Gil Sares, M.D.
• Laura Elizabeth Gil, RPA-C
• Valeria Gil, PA-C
• Ami Lin Gilbert, LMT
• Jamie Rose Gilistro, FNP
• Colleen Mary Gilmartin, PTA
• Angie E Girgis, RPH
• Susie Gladden
• Glow Mental Health Counseling P.C.
• Adam Goldberg, LMHC

• Adult Health Nurse Practitioner in Patchogue, NY
• Providers in Patchogue, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.