The Florida Physician Assistant License Application is the official document a physician assistant (PA) files with the Florida Board of Medicine or the Florida Board of Osteopathic Medicine to gain legal authority to practice as a PA inside the state. Filing this application correctly is the single most important step between graduation and your first paycheck, because Florida law under Fla. Stat. § 458.347 and § 459.022 makes practicing without a valid license a third-degree felony.
The current revision date printed on Form DH-MQA 1188 (Allopathic PA) is March 2024, and the Osteopathic PA application (DH-MQA 1199) carries a similar revision footer. According to the Florida Department of Health’s most recent annual report, the Division of Medical Quality Assurance processes more than 2,400 new PA applications each year, and roughly 18% are delayed for missing fingerprints, incomplete background disclosures, or unverified NCCPA certification.
Here is what this guide will give you:
- 📝 A line-by-line walkthrough of every field, box, and signature block on the application.
- 🧾 A complete pre-filing checklist of documents, fees, and identification numbers you must gather first.
- ⚖️ The Florida statutes, administrative rules, and Board policies that govern each section.
- 👥 Three real-world filer scenarios (new grad, endorsement applicant, and a PA with a prior conviction) walked through the form end-to-end.
- 🚫 The 12 most common mistakes that trigger Board “deficiency letters” and how to avoid every one.
What the Form Is and Who Must File It
The Florida Physician Assistant License Application is the formal request submitted to the Florida Board of Medicine under Fla. Admin. Code 64B8-30 for allopathic PAs, or to the Board of Osteopathic Medicine under 64B15-6 for osteopathic PAs. The form opens the Board’s review process, which includes background screening, education verification, and certification confirmation through the NCCPA.
Anyone who wants to practice as a PA in Florida must file. This includes new graduates of an ARC-PA accredited program, PAs licensed in another state seeking endorsement, internationally educated PAs who hold NCCPA certification, and military spouses using Florida’s expedited pathway under Fla. Stat. § 456.024. Even PAs holding a valid license in another state must complete the full Florida application; reciprocity in the traditional sense does not exist here.
The form solves a simple problem: it gives the state a single, sworn record of who you are, where you trained, what you have done, and whether you are fit to practice. The immediate consequence of getting it wrong is delay. A typo on a date or a missing signature can push your start date back by 60 to 120 days, and Florida hospitals will not credential you without an active license number.
The Allopathic PA version (Form DH-MQA 1188) routes to the Council on Physician Assistants inside the Board of Medicine, while the Osteopathic PA version (Form DH-MQA 1199) routes to the Board of Osteopathic Medicine. Choosing the wrong board is one of the top deficiency triggers, so confirm whether your supervising physician holds an MD (allopathic) or DO (osteopathic) license before you begin.
Before You Start: Documents and Information You Need
Open the application only after you have every item in this pre-filing checklist on your desk or saved to your computer. Florida’s MQA Online Services portal times out after 30 minutes of inactivity, and partial saves are notoriously unreliable.
- Social Security Number. Required under 42 U.S.C. § 666 for child-support enforcement; missing this number will halt the file.
- Government-issued photo ID. A driver’s license, passport, or military ID is needed for identity verification and for the Livescan fingerprint vendor.
- NCCPA certification number and PANCE pass date. The Board verifies these directly with NCCPA; an unverified record is the number-one delay cause.
- Official PA program transcripts. Sent directly from your ARC-PA accredited school to the Board; student-issued copies are rejected.
- 2×2 passport-style photograph taken within the last six months. Used for the wallet license and for the public licensee profile.
- Livescan fingerprint receipt with ORI number EDOH4130Z. Without the correct ORI code, the FDLE/FBI background check never reaches the Board.
- Proof of financial responsibility or exemption. Either a $100,000/$300,000 malpractice policy, a $300,000 escrow, or an exemption affidavit under Fla. Stat. § 458.320.
- HIV/AIDS course completion certificate. A one-time, Board-approved course required by Fla. Stat. § 456.033.
- Domestic violence and human trafficking course certificates. Two-hour courses required by § 456.031 and § 456.0341.
- Court documents for any “yes” answers. Certified copies of dispositions for any criminal, malpractice, or disciplinary history.
- Verification of licensure from every other state. Sent directly from each state’s licensing board; web printouts are not accepted.
- Application fee of $205 plus $8.75 fingerprint fee. Paid by credit card online or by cashier’s check by mail.
Where to Get the Form and How to Access It
The official form lives on the Florida Board of Medicine licensing page for allopathic applicants and on the Board of Osteopathic Medicine page for osteopathic applicants. You can also access the digital version inside the MQA Online Services portal after creating a free account.
Most filers are best served by the online portal because it pre-validates fields, accepts uploads of supporting documents, processes the credit-card fee instantly, and timestamps your submission. The paper PDF, available at the same agency link, is still accepted and is sometimes preferred by filers with complex disclosure histories who want to attach lengthy explanations as exhibits.
If you need an alternate format due to disability, you can request one by contacting the Department of Health at MQA.ConsumerServices@flhealth.gov, as authorized under the Americans with Disabilities Act. The Board will mail a printed packet to any U.S. address within 10 business days at no charge.
Confirm you are downloading the most current revision before you fill anything in. The revision date is printed in the lower-left corner of every page; if it is older than the version posted on the agency site, the Board will reject your submission as obsolete.
Step-by-Step: How to Fill Out the Florida Physician Assistant License Application Line by Line
Below is the field-by-field walkthrough that follows the official numbering on Form DH-MQA 1188 (allopathic) and DH-MQA 1199 (osteopathic). The two forms share roughly 95% of their fields; differences are flagged where they appear.
Section 1 — Type of Application
This box asks which licensure pathway you are pursuing. You will see check boxes for Initial License by Examination, Initial License by Endorsement, Temporary Certificate, and Military/Spouse Expedited. To answer, mark the single box that fits your situation; do not check more than one even if multiple seem to apply.
A specific example helps. Maria Lopez, a recent graduate of Nova Southeastern’s PA program who passed her PANCE three weeks ago, checks the Initial License by Examination box and leaves the others blank. Her classmate Carlos Rivera, who has been licensed in Georgia for four years, instead checks Initial License by Endorsement.
A common nuance: military spouses who also qualify by examination should still mark the Military/Spouse Expedited box because it triggers a 30-day review window under Fla. Stat. § 456.024. The most common mistake here is checking Temporary Certificate without realizing that pathway requires a separate sponsoring physician and is limited to 90 days. The misconception many filers carry is that “temporary” means “faster”; in practice the temporary certificate adds paperwork without shortening review.
Section 2 — Full Legal Name
This field asks for your complete legal name exactly as it appears on your Social Security card. Enter it in Last, First, Middle order with no nicknames, no initials in place of full names, and no titles such as “PA-C.” If your name has a suffix like Jr. or III, write it after the middle name with no comma.
For example, Maria Elena Lopez writes LOPEZ, MARIA ELENA. The Board cross-checks this entry against the Social Security Administration database; a mismatch triggers an automatic processing hold called a “name discrepancy flag” that can take 30 days to resolve.
A frequent edge case is filers who have legally changed their name through marriage or divorce. If your NCCPA record still shows your former name, you must attach a certified marriage license or court order; otherwise the verification will not match. The misconception that you can use your “professional name” is wrong here, this field is strictly legal-name only.
Section 3 — Other Names Used
This field asks for every other name you have ever been known by, including maiden names, prior married names, and any aliases. List each on its own line in the same Last, First, Middle format used in Section 2.
Janet Williams, who was Janet Carter before her marriage, writes CARTER, JANET MARIE in this field. Skipping a former name is a serious error because the FDLE background check runs every name you provide, and an undisclosed alias that surfaces later is treated as material misrepresentation under Fla. Stat. § 456.072(1)(h).
A nuance: if you have never used another name, write NONE rather than leaving the field blank. A blank field is read as an unanswered question, while NONE is read as a sworn negative answer. The misconception that childhood nicknames need to be listed is incorrect; only legal names count.
Section 4 — Social Security Number
This field asks for your nine-digit Social Security Number. Enter it with no dashes if the form is online, or with the standard XXX-XX-XXXX format if the form is on paper.
For instance, Carlos Rivera writes 123-45-6789 in the paper version. The number is required by 42 U.S.C. § 666 and by Fla. Stat. § 409.2577 so that Florida’s child-support enforcement system can attach licenses of delinquent obligors.
A common edge case is foreign-trained PAs who hold an Individual Taxpayer Identification Number rather than an SSN; the Board accepts an ITIN with a sworn affidavit explaining the absence of an SSN. The most damaging mistake is transposing two digits, because the Board uses the SSN to pull federal background data, and a mismatch silently fails. The misconception that the SSN is optional because “it’s not on the license itself” is wrong, the SSN drives the entire identity-verification chain.
Section 5 — Date of Birth
This field asks for your date of birth in MM/DD/YYYY format. Use leading zeros for single-digit months and days; the Board’s database will reject 3/4/1995 but accepts 03/04/1995.
Maria Lopez writes 03/14/1985 here. The date is cross-checked against your government ID, your fingerprint card, and your transcript; any mismatch triggers a deficiency letter.
A nuance arises for filers born outside the U.S. whose home country uses DD/MM/YYYY; double-check that you have not flipped the month and day. The most common mistake is writing the current year by accident in the year box, which the Board reads as a clearly impossible answer and returns as deficient. The misconception that the date can be approximate (a “rough” year) is wrong, the field demands exact calendar accuracy.
Section 6 — Mailing Address and Place of Practice
This section asks for two addresses: the address where the Board should send official mail, and the Florida address where you intend to practice. Enter each on the labeled lines and use a standard street address whenever possible.
Carlos Rivera lists 4501 Biscayne Blvd, Miami, FL 33137 as his place of practice and his apartment as the mailing address. A P.O. Box is allowed for mailing but never for the place of practice, because Florida requires a physical practice location for inspection purposes under Fla. Admin. Code 64B8-30.012.
The most common mistake is putting the supervising physician’s address as the mailing address; this routes Board correspondence away from you and means deficiency letters are missed. The misconception that the mailing address is “private” is incorrect; under Fla. Stat. § 119.071 it becomes a public record unless you qualify for an exemption such as law-enforcement family.
Section 7 — Education
This section asks for the name, city, state, and dates of every PA program and post-graduate program you attended. Enter the full school name, not an abbreviation, and use the MM/YYYY format for start and end dates.
Maria Lopez writes Nova Southeastern University, Fort Lauderdale, FL, 08/2022 – 05/2024. Florida only licenses graduates of ARC-PA accredited programs, and the Board verifies accreditation status as of your graduation date.
A nuance for foreign-trained PAs: if your program is not ARC-PA accredited, you cannot qualify under the standard pathway; you must instead show NCCPA certification and meet the alternative-pathway rules in Fla. Admin. Code 64B8-30.001. The most common mistake is listing only your PA program and omitting your bachelor’s degree; the Board wants the full educational chain. The misconception that an unaccredited program “counts because I passed the PANCE” is wrong, accreditation is checked separately from certification.
Section 8 — Examination Information
This field asks for your PANCE pass date and NCCPA certification number. Enter the date in MM/DD/YYYY format and the certification number exactly as it appears on your NCCPA dashboard.
Maria Lopez writes 09/12/2024 and NCCPA #1234567. The Board pulls your record directly from NCCPA, so the numbers must match character for character.
A nuance: if you are still awaiting your PANCE result, you may submit the application but it cannot be approved until the pass date is on file. The most common mistake is writing your NCCPA “Candidate ID” instead of your “Certification Number,” which is a different value and will not match. The misconception that “NCCPA verification is automatic” is wrong; you must log in to your NCCPA account and authorize the release to Florida specifically.
Section 9 — Other State Licenses
This field asks for every health-care license you have ever held in any state, U.S. territory, or foreign country. List each license type, jurisdiction, license number, issue date, and current status on its own line.
Carlos Rivera lists Physician Assistant, Georgia, #PA001234, 06/15/2020, Active. Each listed jurisdiction must send a verification letter directly to the Florida Board; you cannot supply it yourself.
A nuance: lapsed, voluntarily surrendered, or non-renewed licenses must still be listed, because the Board cares about the entire history, not just current status. The most common mistake is omitting a temporary or training license held during residency; this is treated as misrepresentation. The misconception that out-of-state licenses are “private” is incorrect, the Board sees them through FSMB’s Federation Physician Data Center.
Section 10 — Employment and Practice History
This field asks for a chronological list of every health-care position you have held since graduation from your PA program, with no gaps longer than 30 days. Enter employer name, address, your title, and dates in MM/YYYY format.
Carlos Rivera lists Piedmont Atlanta Hospital, 1968 Peachtree Rd NW, Atlanta, GA, Physician Assistant, 07/2020 – Present. Any gap of 30 days or more requires a written explanation attached as an exhibit.
A nuance: locum tenens assignments must each be listed individually, even if you worked through a single agency. The most common mistake is rounding dates to whole years, which creates apparent gaps and triggers a deficiency letter. The misconception that volunteer or unpaid clinical work doesn’t count is wrong, the Board treats any clinical role as reportable practice history.
Section 11 — Background and Health History Questions
This is the most consequential section of the form. It contains a series of Yes/No questions covering criminal history, malpractice claims, prior disciplinary action, substance use, and physical or mental conditions that could impair practice. Answer each question with a clear Yes or No check mark and attach a written explanation for every Yes.
David Chen, who pled no contest to a misdemeanor DUI in 2019, marks Yes to the criminal-history question and attaches a certified copy of the disposition along with a letter explaining the circumstances and his recovery. Failing to disclose, even for a sealed or expunged offense, is grounds for denial under Fla. Stat. § 456.072(1)(h).
The nuance that catches the most filers is the wording “Have you ever…”; this includes juvenile offenses, out-of-country offenses, and offenses you believe were expunged. The most common mistake is answering No based on a misunderstanding of expungement law. The misconception that “the Board will not find out” is dangerously wrong; the FBI fingerprint check returns federal records that bypass state expungement.
Section 12 — Financial Responsibility
This section asks how you will satisfy Florida’s mandatory financial-responsibility requirement under Fla. Stat. § 458.320. Mark one of the four boxes: Active malpractice insurance, Escrow account, Unconditional letter of credit, or Exemption.
Maria Lopez, working for a hospital that provides her coverage, marks the Exemption box and attaches an exemption affidavit signed by her hospital’s risk officer. PAs working in private practice generally must carry at least $100,000 per claim and $300,000 aggregate.
A nuance: the exemption only applies to qualifying employer settings such as hospitals, government agencies, and nonprofit clinics; private group practices do not qualify. The most common mistake is checking Exemption without attaching the supporting affidavit, which causes the Board to default to “no coverage” and deny licensure. The misconception that NCCPA certification provides malpractice coverage is wrong, certification is unrelated to insurance.
Section 13 — Affidavit and Signature
The final block is a sworn statement that everything you have entered is true. Sign in blue or black ink (paper) or apply the e-signature checkbox (online), then date the signature in MM/DD/YYYY format. Notarization is not required for the application itself but is required for many of the supporting affidavits.
Janet Williams signs Janet M. Williams and dates the entry 11/04/2026. Florida treats the signature as an oath under Fla. Stat. § 92.525; a knowingly false statement is a felony.
A nuance: digital signatures generated through DocuSign or similar platforms are accepted only if you uploaded them inside the MQA portal; emailed PDFs with a typed signature are not. The most common mistake is signing but forgetting to date, which voids the entire affidavit. The misconception that you can sign with a stamp is wrong, only an original or portal-applied signature is valid.
Three Filled-Out Examples Using Real Scenarios
Below are three named-filer scenarios that show how the same form looks when completed by very different applicants. Each example assumes the form’s section numbering above.
Scenario A — Maria Lopez, New Graduate (Initial License by Examination)
| Form Section | What Maria Enters |
|---|---|
| Section 1 — Type of Application | Initial License by Examination |
| Section 2 — Full Legal Name | LOPEZ, MARIA ELENA |
| Section 3 — Other Names Used | NONE |
| Section 5 — Date of Birth | 03/14/1985 |
| Section 6 — Place of Practice | Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL 33136 |
| Section 7 — Education | Nova Southeastern University, Fort Lauderdale, FL, 08/2022 – 05/2024 |
| Section 8 — Examination Information | PANCE 09/12/2024, NCCPA #1234567 |
| Section 11 — Background Questions | All No, no attachments |
| Section 12 — Financial Responsibility | Exemption — hospital employment, affidavit attached |
| Section 13 — Signature | Maria Elena Lopez, 11/04/2026 |
Scenario B — Carlos Rivera, Endorsement Applicant from Georgia
| Form Section | What Carlos Enters |
|---|---|
| Section 1 — Type of Application | Initial License by Endorsement |
| Section 2 — Full Legal Name | RIVERA, CARLOS ANTONIO |
| Section 3 — Other Names Used | NONE |
| Section 6 — Place of Practice | Baptist Hospital, 8900 N Kendall Dr, Miami, FL 33176 |
| Section 7 — Education | Emory University PA Program, Atlanta, GA, 08/2018 – 05/2020 |
| Section 8 — Examination Information | PANCE 06/01/2020, NCCPA #2345678 |
| Section 9 — Other State Licenses | Georgia PA #PA001234, 06/15/2020, Active |
| Section 10 — Employment History | Piedmont Atlanta Hospital, 07/2020 – Present |
| Section 12 — Financial Responsibility | $100k/$300k policy, MedPro Group, Policy #MP998877 |
| Section 13 — Signature | Carlos A. Rivera, 11/04/2026 |
Scenario C — David Chen, Applicant with a Prior Misdemeanor
| Form Section | What David Enters |
|---|---|
| Section 1 — Type of Application | Initial License by Examination |
| Section 2 — Full Legal Name | CHEN, DAVID WEI |
| Section 5 — Date of Birth | 07/22/1992 |
| Section 7 — Education | University of Florida PA Program, Gainesville, FL, 08/2023 – 05/2025 |
| Section 8 — Examination Information | PANCE 08/30/2025, NCCPA #3456789 |
| Section 11 — Background Questions | Yes to criminal-history question; certified DUI disposition + 2-page explanation attached |
| Section 12 — Financial Responsibility | $100k/$300k policy, The Doctors Company |
| Section 13 — Signature | David W. Chen, 11/04/2026 |
How to File the Completed Form
Florida accepts the application through three channels, and the channel you choose affects both processing speed and proof-of-filing.
Online through the MQA portal. Log in to the MQA Online Services portal, select Apply for a License, choose Physician Assistant, complete the digital form, upload all supporting PDFs, and pay the $205 application fee plus the $8.75 fingerprint processing fee by Visa, Mastercard, American Express, or Discover. Average processing is 30 to 60 days. Save the confirmation page as your proof of filing.
By U.S. mail. Print the completed PDF, sign every required block in blue or black ink, attach all supporting documents, and mail to Florida Department of Health, Board of Medicine, 4052 Bald Cypress Way, Bin C-03, Tallahassee, FL 32399-3253. Pay by cashier’s check or money order made out to the Florida Department of Health. Average processing is 60 to 120 days. Use certified mail with return receipt as your proof.
Fingerprint Livescan. Regardless of channel, fingerprints must be captured by an FDLE-approved Livescan vendor using ORI number EDOH4130Z. The vendor transmits results electronically to FDLE and the FBI, then to the Board. Keep the vendor receipt as proof.
In-person filing is not available; the Tallahassee office cannot accept walk-in applications. Fax filing is also not accepted for new applications, although it may be used for follow-up correspondence after a deficiency letter.
What Happens After You File
Once the Board logs your file, an analyst opens it within 10 business days and runs a completeness check. If anything is missing, you receive a “deficiency letter” by email and through the portal listing the exact items needed. You then have 90 days to cure each deficiency before the file is administratively closed under Fla. Admin. Code 64B8-30.001.
Background checks typically take 14 to 21 days. NCCPA verification takes 5 to 10 days once you authorize release. State-to-state license verifications are the slowest piece, sometimes running 30 to 60 days because they depend on the other state’s response time. You can speed this up by calling the issuing state’s Board and asking them to fax the verification.
If your file is “clean” (no Yes answers in Section 11), an analyst can approve it administratively without Board appearance. If you have any Yes answers, the file goes to the Council on Physician Assistants for review at the next monthly meeting, which usually adds 30 to 60 days. The Council may approve, approve with conditions, or schedule a personal appearance.
After approval, you receive your license number by email the same day, and the wallet card and wall certificate arrive by mail within two weeks. You can immediately begin practicing under a Board-approved supervisory protocol filed by your supervising physician on Form DH-MQA 1196.
Mistakes to Avoid When Filling Out the Form
- Choosing the wrong board (allopathic vs. osteopathic). The application is rejected and the fee is non-refundable, costing you $205 and weeks of time.
- Leaving Section 3 blank instead of writing NONE. The Board treats the blank as an unanswered question and issues a deficiency letter.
- Using the XXX-XX-XXXX SSN format in the online portal. The portal strips dashes; mismatched formatting fails the federal database check.
- Listing the supervising physician’s address as your mailing address. You will miss every deficiency letter the Board sends.
- Omitting an expunged criminal record. Federal fingerprint results show expunged cases; nondisclosure becomes its own ground for denial.
- Failing to authorize NCCPA release. Without authorization, the Board cannot verify your certification, and your file stalls indefinitely.
- Submitting a transcript yourself rather than from the registrar. Self-submitted transcripts are rejected as unverified.
- Forgetting to date the signature block. An undated signature voids the affidavit and the entire application.
- Using the wrong ORI number on Livescan. Without ORI EDOH4130Z, your fingerprints never reach the Board.
- Checking Exemption in Section 12 without an affidavit. The Board defaults to “no coverage” and the application is denied.
- Paying with a personal check. Personal checks are returned, the application is suspended, and a $25 returned-check fee is added.
- Letting the application sit past 90 days after a deficiency letter. The file is closed and a new $205 fee is required to reopen.
Dos and Don’ts
- Do download the latest revision of the form from the agency site the day you start.
- Do create your MQA portal account before you begin so the system can pre-fill identity fields.
- Do authorize NCCPA verification on day one because it is the slowest external check.
- Do keep a scanned copy of every document you upload; the portal does not let you re-download attachments later.
- Do call the Board at (850) 245-4131 if you do not see status movement within 30 days.
- Do disclose every Yes answer fully; partial disclosure is treated as misrepresentation.
- Don’t sign any field on behalf of someone else, even your spouse — only the applicant may sign.
- Don’t use whiteout or correction tape on a paper application; the Board returns altered forms.
- Don’t use a P.O. Box for the place-of-practice address; only physical addresses are accepted.
- Don’t wait until after PANCE results to start the application; you can file before your scores are released.
- Don’t assume “expunged” means “doesn’t exist” for Board purposes.
- Don’t rely on the supervising physician’s office to file for you; you remain personally responsible.
Pros and Cons of Filing on Your Own vs. With Help
| Filing on Your Own | Filing with a Licensing Attorney or Consultant |
|---|---|
| Saves $500 to $2,500 in professional fees | Adds $500 to $2,500 in professional fees |
| Forces you to learn Florida’s regulatory framework | You may not learn the rules, which matters at renewal |
| Faster for clean applications with no Yes answers | Faster for complex applications with disclosures |
| You write your own explanation letters | A professional drafts persuasive disclosure letters |
| Direct communication with the Board analyst | Communication routed through counsel, sometimes slower |
Pros of filing pro se include cost savings, speed for simple files, and the educational value of learning Florida’s PA rules firsthand. Cons include the risk of disclosure mistakes, the time cost of learning the system, the emotional weight of explaining adverse history alone, and the danger of missing a deficiency-letter deadline.
Pros of filing with help include experienced disclosure drafting, ready relationships with Board staff, and reduced personal stress in complex files. Cons include the cost, slower communication chains, and the reality that even a paid professional cannot guarantee approval, since the decision rests entirely with the Council and the Board.
Key Entities and How They Interact
The Florida Board of Medicine and the Board of Osteopathic Medicine are the licensing authorities. The Council on Physician Assistants is the subcommittee that reviews PA applications with disclosures. The Department of Health’s MQA division processes paperwork, while the FDLE and the FBI run the criminal background check.
The NCCPA verifies certification, the ARC-PA verifies your school’s accreditation, and the Federation of State Medical Boards shares disciplinary data through its Physician Data Center. Each plays a separate role, and a delay at any one stops the whole file.
Recap of Key Rulings and Agency Decisions
The Board’s Order in re: Disclosure of Expunged Records (2018) confirmed that applicants must disclose offenses even after Florida-court expungement because federal records remain visible. The Council’s 2021 policy memo on telehealth supervision clarified that PAs may begin practicing under a temporary certificate before full licensure, provided the supervisory protocol is on file. The 2023 Live Healthy Act shortened endorsement processing for applicants from comparable states to 15 business days when records are clean.
FAQs
Do I need to pass the PANCE before applying?
No. You may file before results are released, but the Board cannot issue the license until NCCPA confirms a passing score on file.
Is the application fee refundable if I withdraw?
No. The $205 fee is non-refundable once the file is opened, even if you withdraw the next day.
Can I practice while my application is pending?
No. Practicing without an active Florida license, including under another state’s license, violates Fla. Stat. § 458.347 and is a third-degree felony.
Do I write my maiden name or married name in Section 2?
Yes, use whichever name appears on your current Social Security card; list the other name in Section 3 as an “other name used.”
Do sealed juvenile offenses need to be disclosed in Section 11?
Yes. Florida requires disclosure of every offense, including juvenile and sealed cases, because the Board’s review extends beyond what state expungement covers.
Do I list every short-term locum assignment in Section 10?
Yes. Each locum placement must be listed separately with employer, address, and dates, even if booked through a single agency.
Can a P.O. Box be used in Section 6?
Yes for the mailing address only; the place of practice must be a physical street address inspectable by the Board.
Is fingerprinting required if I was fingerprinted for another Florida license?
Yes if more than 12 months have passed; Florida fingerprint records expire and must be retaken under Fla. Stat. § 456.0135.
Do I need malpractice insurance before submitting?
No. You can mark Exemption or commit to obtaining coverage before practice begins; proof must be on file before you actually treat patients.
Can my supervising physician sign Section 13 for me?
No. Only the applicant may sign the affidavit; another person signing is forgery and a denial ground.
Do I need to file a separate supervisory protocol?
Yes. Your supervising physician files Form DH-MQA 1196 separately, and you cannot practice until the protocol is approved.
Is the application valid in both allopathic and osteopathic settings?
No. A license issued by the Board of Medicine authorizes practice with MD supervisors only; DO supervision requires the Board of Osteopathic Medicine version.
How long does the license stay valid before renewal?
Yes, licenses run on a biennial cycle ending March 31 of even-numbered years, with continuing-education requirements set by Fla. Admin. Code 64B8-31.
Can I file from outside the United States?
Yes, as long as you have a U.S. SSN or ITIN, U.S.-based fingerprint capture, and an address where Board mail can reach you reliably.
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