Provider Demographics
NPI:1902914096
Name:ACHTYL, JOSEPH MICHAEL (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:ACHTYL
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CELEBRATION PL
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5433
Mailing Address - Country:US
Mailing Address - Phone:407-303-3820
Mailing Address - Fax:407-303-3821
Practice Address - Street 1:410 CELEBRATION PL
Practice Address - Street 2:SUITE 401
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5433
Practice Address - Country:US
Practice Address - Phone:407-303-3820
Practice Address - Fax:407-303-3821
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2015-02-09
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2013-09-25
Provider Licenses
StateLicense IDTaxonomies
NY300982363LA2200X
FLARNP9362971363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health