Get Va Nurse Practitioner License Verification Form 2018-2025

This guide provides clear instructions on completing the VA Nurse Practitioner License Verification Form online. By following these steps, users can efficiently navigate the form and ensure accurate submission to the relevant authorities.

Follow the steps to complete the form online efficiently.

1. Press the ‘Get Form’ button to access the VA Nurse Practitioner License Verification Form and open it in your preferred format.
2. Begin by filling out the top section of the form, entering your last name, first name, middle name, and social security number.
3. Provide your current address where you can be reached.
4. Enter your Nurse Practitioner License number and the name as it appears on your original license.
5. Indicate the year your license was issued.
6. Complete the following section by entering your full name again, including your last, first, and middle names, as well as your maiden name if applicable.
7. State the name of your Master’s or Graduate Degree Program and the city, state, or province where it is located.
8. Choose the type of program you completed by selecting from the options: Master’s, MSN, Post, or Other, and provide additional details if you select 'Other'.
9. Input the program completion date and the length of the program.
10. Record the accrediting authority that approved your Master’s or Graduate Degree Program.
11. Fill in your license number and the date it was granted.
12. Select your license status from the following options: Current, Lapsed, Endorsement, Waiver, or Inactive.
13. If your license has ever been suspended, revoked, or otherwise disciplined, indicate 'Yes' or 'No'. Attach any necessary documentation if you answered 'Yes'.
14. Certify your information by signing and dating the form in the designated area.
15. Once all fields are completed, save your changes, and you may choose to download, print, or share the verification form.

Complete your VA Nurse Practitioner License Verification Form online today for a swift submission process.