Healthcare Provider Details

I. General information

NPI: 1083957971
Provider Name (Legal Business Name): TIFFANY MICHELLE CAGLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E NC HIGHWAY 54 STE 205
DURHAM NC
27713-2552
US

IV. Provider business mailing address

601 S KINGS DR STE F #166
CHARLOTTE NC
28204
US

V. Phone/Fax

Practice location:
  • Phone: 919-419-0242
  • Fax:
Mailing address:
  • Phone: 984-277-3673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2015-01827
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: