Follow the steps to complete your application form online.

1. Click the ‘Get Form’ button to access the application form and open it within your browser.
2. Fill in your full name in the designated fields. Start with your last name, followed by your first and middle name as applicable.
3. Enter your U.S. Social Security Number or Individual Tax Identification Number as requested. Ensure this information is accurate to avoid processing delays.
4. Provide your address details, including street address, city, state, and zip code, in the corresponding fields.
5. Input your email address where you can receive confirmations and communications regarding your application.
6. Fill in your date of birth in the specified format.
7. Indicate the name of your Nurse Practitioner Program, including the city, state, and country where it was completed.
8. Acknowledge all applicable fees paid online by credit card, ensuring you select the correct option for the application fee of $50.00.
9. Confirm whether you have enclosed any supplemental information regarding prior convictions or discipline against licenses, checking 'YES' or 'NO' as appropriate.
10. Read the certification statement carefully. You must certify that all information provided is true, correct, and complete under penalty of perjury.
11. Sign and date the application in the designated fields. Your signature is a declaration of the accuracy of your information.
12. After completing all sections, ensure all information is filled out correctly. Save your changes, and then proceed to download, print, or share the completed form as required.

Start filling out your CA DCA Online Nurse Practitioner Furnishing Number Application Identification online today to ensure a smooth application process.