Florida
(Application Types: All) ☐ Type of services provided. Request to Change the . Services ☐ Sections 1, 2 , 4 and 6 of the Application for Certificate of Exemption from Licensure as a Home Health Agency, AHCA Form 3110-1009, July 2018. ☐ $25.00 fee for replacement certificate. Request to Change the Address or Name of Provider ................
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