NP autonomy in Florida: autonomous APRN practice and finding a collaborating physician

Can nurse practitioners practice independently in Florida?

The statute’s answer: an APRN practices “within the framework of an established protocol that must be maintained on site”, unless “registered and practicing under s. 464.0123” (s. 464.012(3)). Florida had 54,783 active APRNs on June 30, 2026, and 13,340 physician assistants, who have no autonomous route (see the FAQ).

Sources: ss. 456.041, 456.048, 464.012, 464.0123 and 464.0155, Florida Statutes (2026); Board of Nursing, Rule 64B9-4, F.A.C.

What is a collaborating physician under Florida law?

Florida’s nursing statute speaks of supervising physicians and a “supervisory protocol”; “collaborating physician” is the term in Medicare’s rule (42 CFR 410.75(c)(3)).

• The protocol. A copy stays at each location where the APRN practices, and in a group with several supervising physicians, the APRN “must enter into a supervisory protocol with at least one physician within the physician group practice” (s. 464.012(3)).
• The supervision. The Board of Nursing’s rule defines general supervision: the supervising practitioner “need not be present”, but the APRN must be able to reach them in person or by communication device (Rule 64B9-4.001(14)).
• The physician’s filing. The physician gives notice to the Board of Medicine within 30 days of entering the protocol and within 30 days after ending it (s. 458.348(1)(b)); osteopathic physicians follow the same rule (s. 459.025).
• The public record. The protocol is included in the APRN’s practitioner profile (s. 456.041(1)(a)).

How do you find a collaborating physician in Florida?

Check three things before you sign.

• The license. Confirm the physician’s license is clear and active on DOH’s license search; our guide to verifying a Florida license explains each status.
• The physician’s capacity. A physician who supervises an APRN or PA at an office other than their primary practice location, with no physician on site, may cover no more than four such offices in primary care and two in specialty care. Dermatology or skin care allows one, within 25 miles or in a contiguous county, for a physician board certified or board eligible in dermatology or plastic surgery. Each office must post the hours the physician is there. Hospitals, rural and federally qualified health centers, government facilities and the other settings the statute lists are exempt (s. 458.348(3)).
• The plans. Insurers can add their own conditions on the collaborating physician; NP and PA credentialing lists them plan by plan.

How does a nurse practitioner register as autonomous in Florida?

The Board of Nursing registers an APRN who meets four conditions (s. 464.0123(1)):

1. An active, unencumbered Florida APRN license.
2. No discipline under s. 456.072 or s. 464.018, or similar action in another state, in the 5 years before the request.
3. At least 3,000 clinical practice hours in those 5 years, practicing as an APRN under physician supervision. Hours under a physician licensed in any state count, and so do clinical instructional hours you provided.
4. Three graduate semester hours in differential diagnosis and three in pharmacology, within 5 years; under Board rule, 45 continuing education credits equal 3 semester hours (Rule 64B9-4.020(3)).

Once registered, you keep the malpractice coverage in the table, and each two-year renewal requires at least 10 Board-approved continuing education hours “in addition to completing 30 hours” otherwise required (s. 464.0123(5)).

What is the scope of practice for an autonomous nurse practitioner?

The statute allows autonomous practice “only in primary care practice, including family medicine, general pediatrics, and general internal medicine, as defined by board rule” (s. 464.0123(3)(a)1.). The Board’s rule defines primary care to include “diagnosis and treatment of acute and chronic illnesses, inclusive of behavioral and mental health conditions” (Rule 64B9-4.001(12)), and the statute bars “any surgical procedure other than a subcutaneous procedure” (s. 464.0123(3)(c)).

• What registration adds. An autonomous APRN may admit patients to a health care facility, manage their care there and, unless federal law or rule prohibits it, discharge them, and may sign a certification or affidavit “otherwise required by law to be provided by a physician”, except the medical marijuana certification under s. 381.986 (s. 464.0123(3)(a)4.–5.).
• Certified nurse midwives. They may practice midwifery autonomously; for out-of-hospital births they must keep “a written policy for the transfer of patients needing a higher acuity of care or emergency services” (s. 464.0123(3)(b)).
• What registration requires. A written note to each new patient about your qualifications and the nature of autonomous practice, “before or during the initial patient encounter” (s. 464.0123(7)). An adverse incident, an event within your control that ends in a hospital transfer, a permanent physical injury or a death, is reported to DOH by certified mail, postmarked within 15 days (s. 464.0155). DOH marks the registration on your practitioner profile (s. 464.0123(6)).

How does Florida compare with full practice authority states for NPs?

Florida law’s term is autonomous practice. The national APRN Consensus Model, meant to bring consistency to how states regulate APRNs, lists “independent practice” and “independent prescribing” among its seven elements (NCSBN, 2026). Florida’s registration comes with conditions: 3,000 supervised hours first, primary care only, and the prescribing limits above.

This guide gives no count of full practice authority states for nurse practitioners. Lists of states that let nurse practitioners practice independently trace to a professional association’s map, and no regulator’s count was found; each state’s board of nursing licenses the APRNs who practice there, so check the board in the state you’re considering.

What do Medicare and Florida Medicaid require of a nurse practitioner’s collaborating physician?

Medicare’s rule, 42 CFR 410.75(c)(3), defines collaboration as working with physicians “as provided by the law of the State in which the services are performed”. Where no state law governs collaboration, NPs document their scope of practice and the physicians they work with on issues outside it. How First Coast, Florida’s Medicare contractor, applies that to an autonomous APRN isn’t stated in any source read for this guide: ask First Coast.

“The collaborating physician does not need to be present with the nurse practitioner when the services are furnished or to make an independent evaluation of each patient who is seen by the nurse practitioner.”

• Medicare pay. Allowed amounts for an NP’s services “may not exceed 85 percent of the physician fee schedule amount” (42 CFR 414.56(c)). CMS’s October 2026 enrollment file holds 33,044 nurse practitioner enrollment records in Florida, of 430,425 nationally; enrollment itself is on our Medicare enrollment page.
• Florida Medicaid. It pays APRNs who have “a valid collaboration agreement with a licensed physician on file with the Department of Health”, or who are registered as autonomous, at no less than 80% of what it pays a physician for the same service (s. 409.905(1)). Sole proprietors under a protocol file the Practitioner Collaborative Agreement, AHCA Form 5000-1067 (June 2019), which AHCA marks “Not required for autonomous APRNs” (Florida Medicaid enrollment).

What you can do today

1. Count your supervised clinical hours from the last 5 years, teaching hours included, and gather the transcripts or CE certificates for differential diagnosis and pharmacology.
2. Get malpractice quotes at the statute’s minimums in the table before you apply, or price a letter of credit for the same amounts.
3. If you’ll keep a protocol, look the physician up on DOH’s license search and ask how many offices they already supervise without a physician on site.
4. Draft the new-patient disclosure now, so it is ready for the first visit after registration.
5. When your status changes, tell Florida Medicaid and each plan you’re enrolled with: Form 5000-1067 drops away once you’re autonomous. If you’re opening your own office, starting a practice in Florida lists the filings that come first.

Advixor’s NP and PA credentialing service covers initial enrollment and credentialing with commercial health plans, Medicare and Medicaid, and the maintenance that follows.