Change of Address for Applicants/Current Licensees
Mission:
To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.
Ron DeSantis Governor
Joseph A. Ladapo, MD, PhD State Surgeon General
Vision: To be the Healthiest State in the Nation
Change of Address for Applicants/Current Licensees
Did you know you can update your address online? Current licensees can update their address at .
*Profession and License Number: *Name (as printed on license): *Date of Birth (MM/DD/YYYY): NEW Mailing Address:
*Last Four Digits of Social Security Number:
City:
State:
ZIP:
Country (other than US):
NEW Practice Location Address:
City:
State:
ZIP:
Country (other than US):
Home Telephone Number:
Work Telephone Number:
Email Address:
Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not provide an email address or send electronic mail to our office. Instead contact the office by phone or in writing.
*Signature:
Date (MM/DD/YYYY):
*Required field. For your protection, we ask for specific information to verify your identity. Incomplete requests will not be processed.
For Applicants:
Department of Health Medical Quality Assurance Board of Nursing 4052 Bald Cypress Way, Bin C-02 Tallahassee, Florida 32399-3252 Telephone: (850) 245-4125
For Current Licensees:
Department of Health Medical Quality Assurance Licensure Services Support Unit P.O. Box 6320 Tallahassee, Florida 32314 Telephone: (850) 488-0595
Florida Department of Health Division of Medical Quality Assurance Bureau of Health Care Practitioner Regulation Board of Nursing 4052 Bald Cypress Way, Bin C-02 ? Tallahassee, FL 32399 PHONE: 850/245-4125 ? FAX: 850/617-6460
Accredited Health Department
Public Health Accreditation Board
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