Individual
THARA L GUILLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1300 STATION DR APT 1303, AVENEL, NJ 07001-1869
(386) 868-9658
Mailing address
1300 STATION DR APT 1303, AVENEL, NJ 07001-1869
(386) 868-9658
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
RN9573108
FL
363LA2200X
Adult Health Nurse Practitioner
N10571
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
RN9573108
FL
Other
Enumeration date
10/21/2025
Last updated
10/21/2025
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