VA Nurse Practitioner License Verification Form 2016 free printable template
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COMMONWEALTH OF VIRGINIA Department of Health Professions Board of Nursing Perimeter Center 9960 Maryland Drive, Suite 300 Enrico, VA 232331463 (804)3674515 PHONE (804) 5274455 FAX web: www.dhp.virginia.gov/nursing
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How to fill out VA Nurse Practitioner License Verification Form
01
Obtain the VA Nurse Practitioner License Verification Form from the appropriate VA website or office.
02
Fill in your personal information including your name, address, and contact details accurately.
03
Provide your Nurse Practitioner license number and state of issuance.
04
Include information about your education and training, such as the institution's name and dates attended.
05
List any certifications or specializations you hold that are relevant to your practice.
06
Sign and date the form to certify that the information provided is true and accurate.
07
Submit the completed form to the designated VA licensing office as instructed, ensuring you keep a copy for your records.
Who needs VA Nurse Practitioner License Verification Form?
01
Nurse Practitioners applying for a job or credentialing within the VA system.
02
Nurse Practitioners needing to verify their license status for compliance or regulation requirements.
03
Healthcare employers or organizations that require verification of a Nurse Practitioner's licensure.
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What is VA Nurse Practitioner License Verification Form?
The VA Nurse Practitioner License Verification Form is a document used to verify the professional licensure of nurse practitioners who wish to work within the Veterans Affairs system.
Who is required to file VA Nurse Practitioner License Verification Form?
Nurse practitioners seeking employment or privileges within the VA system are required to file the VA Nurse Practitioner License Verification Form.
How to fill out VA Nurse Practitioner License Verification Form?
To fill out the VA Nurse Practitioner License Verification Form, applicants must provide their personal details, including name, contact information, licensing state, and license number, along with any necessary documentation as specified by the VA guidelines.
What is the purpose of VA Nurse Practitioner License Verification Form?
The purpose of the VA Nurse Practitioner License Verification Form is to ensure that nurse practitioners have valid and current licenses to practice before they are granted employment or privileges at VA facilities.
What information must be reported on VA Nurse Practitioner License Verification Form?
The information that must be reported on the VA Nurse Practitioner License Verification Form includes the practitioner's full name, date of birth, license number, issuing state, expiration date, and any disciplinary actions taken against the license.
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