MEDICARE: MS. AGNES YOUNGSHIM JO FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024180309	VA

General Provider Information

NPI Number	:	1275018418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AGNES YOUNGSHIM JO FNP-C

Provider Business Mailing Address
First Line	:	2800 S SHIRLINGTON RD STE 500
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-3618
Country	:	US
Telephone Number	:	703-717-4245
Fax Number	:	703-717-4248

Provider Business Practice Location Address
First Line	:	2800 S SHIRLINGTON RD STE 500
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-3618
Country	:	US
Telephone Number	:	703-717-4245
Fax Number	:	703-717-4248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2018
Last Update Date	:	10/15/2021

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