Healthcare Provider Details

I. General information

NPI: 1689518847
Provider Name (Legal Business Name): TIFFANY DECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 E MALLARD CT
GILBERT AZ
85234-3813
US

IV. Provider business mailing address

2333 E MALLARD CT
GILBERT AZ
85234-3813
US

V. Phone/Fax

Practice location:
  • Phone: 602-710-5070
  • Fax:
Mailing address:
  • Phone: 602-710-5070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number337693
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: