Provider Demographics
NPI:1245558014
Name:CADDLE, TONYA T
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:T
Last Name:CADDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3423
Mailing Address - Country:US
Mailing Address - Phone:910-202-4318
Mailing Address - Fax:910-799-5020
Practice Address - Street 1:4715 MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3423
Practice Address - Country:US
Practice Address - Phone:910-202-4318
Practice Address - Fax:910-799-5020
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management