Provider Demographics
NPI:1275018418
Name:JO, AGNES YOUNGSHIM (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:AGNES
Middle Name:YOUNGSHIM
Last Name:JO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 S SHIRLINGTON RD STE 500
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3618
Mailing Address - Country:US
Mailing Address - Phone:703-717-4245
Mailing Address - Fax:703-717-4248
Practice Address - Street 1:2800 S SHIRLINGTON RD STE 500
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3618
Practice Address - Country:US
Practice Address - Phone:703-717-4245
Practice Address - Fax:703-717-4248
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180309363LF0000X
NY343753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily