Provider Demographics
NPI:1770363962
Name:ACHENBACH, JACK (RDN)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:ACHENBACH
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13841 OSPREY LINKS RD APT 233
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6164
Mailing Address - Country:US
Mailing Address - Phone:484-886-6357
Mailing Address - Fax:
Practice Address - Street 1:13841 OSPREY LINKS RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6163
Practice Address - Country:US
Practice Address - Phone:484-886-6357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9025133N00000X
FL9025133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist