PA/AA REINSTATMENT LICENSURE
PLEASE CLICK
HERE FOR SIMPLE PA/AA REINSTATEMENT APPLICATION CHECKLIST
Here is the method you should submit your application:
Our EGov Portal: Reinstatement License Application
Reinstatement Lapsed: APPLICATIONS WILL NOT BE REVIEWED WITHOUT APPLICATION FEE Application: $400.00
Reinstatement Inactive: APPLICATIONS WILL NOT BE REVIEWED WITHOUT APPLICATION FEE Application: $200.00
**PLEASE READ OUR CHECKLIST PRIOR TO FILLING OUT FORMS**
FORM A - AFFIDAVIT OF APPLICANT
FORM A2 - Citizenship Affidavit
FORM B - REQUEST FOR ADDITIONAL DUTIES
FORM C - ANESTHESIA REFERENCE FORM
FORM D - PRIMARY CARE REFERENCE FORM
FORM E - ANESTHESIA JOB DESCRIPTION
FORM F - PRIMARY CARE JOB DESCRIPTION
FORM H - SEPARATION NOTIFICATION
FORM I - VERIFICATION OF LICENSURE