Board on Physician Assistants
When completing the application process below, you will be required to submit an official transcript from the institution where you completed your education. The transcript must be mailed directly from the educational institution to the board office located at 665 Mainstream Drive, Nashville, TN 37243.
►Applying for initial licensure from your professional licensing board has become a bit easier. For the past year, the Department of Health has been working on an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions. The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check. You will also be able to upload many of the documents required to complete your initial application! Please go to the initial application link below to begin the online process.
- Notice of intent to Terminate Supervision
- Declaration of Citizenship (PH-4183)
- Declaration of Eligibility for Expedited Licensure Process for a Military Member (PH-4279)
- Declaration of Eligibility for Expedited Licensure Process for a Spouse of a Military Member (PH-4280)
- PA Supervising Physician Form
- Duplicate or Replacement License Form (PH-4057)
- Affidavit of Retirement From Practice in Tennessee (PH-3460)
- Name and Address Change Request
- Application for Licensure as an Orthopedic Physician Assistant (PH-3562)
- Application for Licensure as a Physician Assistant (PH-3563)
- Instructions for Renewal Application
- Mandatory Practitioner Profile Questionnaire for Licensed Health Care Providers (PH-3585)
- Application Instructions for Licensure Reinstatement (PH-3556)