What is my nursing license number
[DOCX File]Virginia Department of Health
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(Signature of Administrator/Chief Officer) (Nursing Home Administrator’s License Number) Conditioned Certificate of Public Need for Indigent and Specialty Care: I hereby certify that the facility named on this application is in compliance with the provisions of the Code of Virginia, 1950, as amended, Title 32.1, Chapter 5, Article 1, Section ...
[DOC File]APPLICATION FOR LICENSE AS NURSING HOME …
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I understand that any final disciplinary action taken against my nursing home administrator’s license will be reported to the (NPDB). I also understand that my social security number will be used in such reporting. TO THE WEST VIRGINIA NURSING HOME ADMINISTRATORS LICENSING BOARD: I, _____, hereby make application to be registered for license ...
[DOC File]TO: _________________________________, Education ...
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Full-time ( Part-time ( North Carolina RN License Number FTE ( 0.25 ( 0.50 ( 0.75 ( 1.0 ( Other _____ *The vitae form is mandatory for NCBON submission and approval of new program directors. **The vitae form is optional for nursing faculty; however, the program director should maintain vitae forms if requested by the NCBON. OR
[DOC File]APPLICATION FOR LICENSE AS NURSING HOME …
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I understand that any final disciplinary action taken against my nursing home administrator’s license will be reported to (npdb). I also understand that my social security number will be used in such reporting. TO THE WEST VIRGINIA NURSING HOME ADMINISTRATORS LICENSING BOARD: I, _____, hereby make application to be registered as an ...
_The Commonwealth of Massachusetts
The Board of Registration in Nursing (Board) will no longer issue paper license renewal reminders or paper licenses beginning with the 2018 renewal period. The Board will use email to communicate renewal reminders and important changes in statute, regulations and policies related to nursing.
[DOCX File]Health Care Licensing Application - FL Agency for Health ...
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During License Period: Request to change the name or address of the provider: Complete and submit Sections 1, 2, and 10 of the Health Care Licensing Application, Health Care Clinic, AHCA Form 3110-0013. $25.00. replacement license fee for change during licensure period. A copy of the facility’s current health care clinic license.
[DOCX File]AHCA USE ONLY: - The Agency For Health Care Administration
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The delivery of nursing home services for which the nursing home is licensed under part II of Chapter 400, to serve its residents in its facility. License Number: The delivery of assisted living facility services for which the assisted living facility is licensed under part I …
THE COMMONWEALTH OF MASSACHUSETTS
Physician State License Number: _____ License Number _____ Expiration Date. I hereby certify that the above named applicant is in good health and has no mental or physical impairment that would prevent him or her from discharging the responsibilities of a Nursing Home Administrator.
[DOC File]KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT
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I do hereby give permission to the department to verify any information provided in this application and any attachments. Attached is my $20.00 certification application fee and copy of identification with my current name and social security number (such as, social security card, driver's license, W-2, etc.)
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