Healthcare Provider Details

I. General information

NPI: 1700362761
Provider Name (Legal Business Name): IZA AMARGO CLARK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 ARLINGTON BLVD
FALLS CHURCH VA
22044-2901
US

IV. Provider business mailing address

6100 ARLINGTON BLVD
FALLS CHURCH VA
22044-2901
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-8627
  • Fax:
Mailing address:
  • Phone: 703-237-8627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024188411
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95018787
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-2473
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: