PA/AA REINSTATMENT LICENSURE

PLEASE CLICK HERE FOR SIMPLE PA/AA REINSTATEMENT APPLICATION CHECKLIST

Here is the method you should submit your application:

1. 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

FORM J - Specific Power of Attorney

PA/AA Utilization Form