Do Florida Nurse Practitioners Need a Supervising Physician?

In most cases, yes. A nurse practitioner in Florida must work under a written supervisory protocol with a licensed physician, osteopathic physician, or dentist. The exception is autonomous practice: since 2020, experienced primary care nurse practitioners who meet specific requirements can register with the Board of Nursing and practice without any physician oversight. Both paths sit under Chapter 464 of the Florida Statutes, and which one applies depends on your experience, your specialty, and whether you’ve completed the autonomous registration.

The Default Rule: A Written Supervisory Protocol

Every advanced practice registered nurse who has not registered for autonomous practice must operate under a written supervisory protocol with a physician, osteopathic physician, or dentist. The protocol is the legal document that authorizes the nurse to diagnose conditions, order tests, and prescribe treatment.¹

Supervision here is not what most people picture. The physician does not have to be physically present for routine care. The arrangement is closer to a collaborative framework: the physician provides general oversight and must be reachable for consultation when more complex situations come up. Florida law does not require a physician looking over your shoulder for every patient encounter, but it does require a defined relationship that structures how you practice.

The protocol must be kept on-site at every location where the nurse practices. If you work with several physicians in the same group, a protocol with at least one physician in the group is enough. The collaborating physician must notify the Board of Medicine within 30 days of entering into or terminating the supervisory relationship.²

How Many Offices a Physician Can Supervise

Florida caps how many locations a single physician can oversee beyond their primary practice site. A physician providing primary health care services may supervise up to four additional offices. A physician providing specialty health care services may supervise up to two additional offices.³ If you’re joining a practice with multiple sites, these limits shape whether your prospective collaborator is actually available to cover you.

The Exception: Autonomous Practice Registration

Under Section 464.0123, qualifying nurses can register with the Board of Nursing to practice without a physician protocol. If you qualify, no supervisory agreement is required at all.

To register, you must meet each of the following:

An active, unencumbered advanced practice registered nurse license under Section 464.012.
At least 3,000 hours of clinical practice under physician supervision within the five years before your application. Clinical instruction hours in a graduate program count.
Three graduate-level semester hours in differential diagnosis and three in pharmacology, both completed within the past five years.
No disciplinary action under Florida’s health practitioner statutes, or comparable action in any other state, within the past five years.⁴

What Autonomous Practice Covers, and What It Doesn’t

Autonomous practice is limited to primary care: family medicine, general pediatrics, and general internal medicine. Certified nurse midwives can also practice autonomously within their scope. An autonomous nurse practitioner may admit patients to health care facilities, manage their care, and discharge them, and may provide signatures, certifications, and verifications that would otherwise require a physician. One carve-out: they cannot issue physician certifications for medical marijuana under Section 381.986. They also may not perform any surgical procedure beyond subcutaneous procedures.⁴

If your specialty falls outside primary care, autonomous practice isn’t currently available, and the supervisory protocol requirement still applies to you.

Liability Coverage Requirement

Autonomous practice carries a financial responsibility requirement that protocol-based practice does not. You must maintain professional liability coverage of at least $100,000 per claim with a $300,000 annual aggregate, or hold an irrevocable letter of credit in the same amounts. The Board of Nursing’s registration application requires you to certify this coverage before approval.⁵

Prescribing Depends on the Protocol

For nurses working under supervision, prescribing authority flows from the protocol itself. The protocol must address the specific drug therapies the nurse is authorized to prescribe, adjust, or monitor. To prescribe any controlled substance, the nurse must have graduated from a program leading to a master’s or doctoral degree in a clinical nursing specialty with training in specialized practitioner skills, and must hold a federal DEA registration.⁶

Schedule II prescriptions are limited to a seven-day supply. That cap does not apply to psychiatric medications prescribed by a psychiatric nurse as defined in Section 394.455. Psychiatric mental health controlled substances for patients younger than 18 may only be prescribed by a nurse who is also a psychiatric nurse.⁶

Telehealth Follows the Same Rules

Florida law lets advanced practice registered nurses provide care through telehealth under the same scope of practice and professional standards that apply to in-person visits. A telehealth evaluation that is sufficient to diagnose and treat a patient satisfies the standard of care, and no separate physical examination is required first.⁷

One boundary applies to every telehealth provider, whether working under a protocol or under autonomous registration: no Schedule II controlled substance may be prescribed via telehealth unless the prescription is for treatment of a psychiatric disorder, inpatient hospital treatment, hospice care, or treatment of a nursing home resident.⁷

APRN or ARNP: Same License

Florida’s statutes now use “advanced practice registered nurse,” abbreviated APRN, and current Board of Nursing documents follow that convention. Older documents, some state forms, and everyday conversation still use “advanced registered nurse practitioner” and the abbreviation ARNP. Both refer to the same license category under Chapter 464.¹

1
Florida Senate. Florida Code 464.012 – Licensure of Advanced Practice Registered Nurses; Fees; Controlled Substance Prescribing
2
Florida Senate. Florida Code 458.348 – Formal Supervisory Relationships, Standing Orders, and Established Protocols; Notice; Standards
3
The Florida Legislature. Florida Code 458.348 – Formal Supervisory Relationships, Standing Orders, and Established Protocols; Notice; Standards
4
Florida Senate. Florida Code 464.0123 – Autonomous Practice by an Advanced Practice Registered Nurse
5
Florida Board of Nursing. Autonomous APRN Registration
6
The Florida Legislature. Florida Code 464.012 – Licensure of Advanced Practice Registered Nurses; Fees; Controlled Substance Prescribing
7
The Florida Legislature. Florida Code 456.47 – Use of Telehealth to Provide Services