50-State Guide

Physician Collaboration Requirements by State

Q: Can one physician collaborate across multiple states?

Yes, but only if the physician is properly licensed in each state where collaboration occurs and meets that state’s specific collaboration requirements. Multi-state collaboration is common, but compliance must be assessed state by state.

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Understanding Physician Collaboration Requirements

What Is Physician Collaboration?

Physician collaboration refers to a formal professional relationship required for some nurse practitioners (NPs/APRNs) to practice or prescribe. Depending on the state, it may involve a written agreement, consultation, chart review, or prescribing conditions. Physician assistant (PA) supervision requirements are distinct and should be checked separately.

Requirements vary by state. Some NPs need an ongoing collaboration relationship, some have a transition period, and others can practice independently. Use the state summaries below as a starting point, then confirm the current requirements with the relevant state board.

Key Takeaways

Requirements differ by state and experience. Collaboration may be ongoing, transitional, or unnecessary for an NP who meets the state’s practice requirements.

Check the agreement and prescribing rules. Where collaboration is required, the state may specify documentation, review, ratio, and prescribing conditions.

Check every state where care is delivered. Telehealth and multi-state operations require attention to the applicable state rules and current licenses.

Physician Collaboration Requirements by State

How to read this guide

Physician collaboration includes required collaboration, supervision or delegation. Independent practice means practicing within the NP’s authorized scope without that required relationship. It does not remove consultation, referral or other professional duties.

All entries assume appropriate NP licensure, certification and scope. Prescribing requires applicable state authority and compliance with drug laws, including controlled substance registrations and limits. Facility, employer, procedure and business ownership requirements may also apply.

AANP categories describe the statewide practice environment and may differ from an individual NP’s eligibility for independence. Categories below reflect AANP’s May 2026 map; state summaries also address subsequent changes, including Wisconsin’s September 2026 implementation. View the AANP State Practice Environment map

This guide provides general information, not legal advice or a complete statement of state law. Consult the linked official sources for eligibility, exceptions and current requirements.

Alabama Physician Collaboration Requirements

AANP practice category: Reduced practice
Physician collaboration required: Yes.
Path to independent practice: No general pathway.
Prescribing: Protocol-based; controlled substances require additional authorization.
Agreement and filing: Written protocol and Board approval required.

Alabama collaboration requirements

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Alaska Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Separate Board prescribing authorization required.
Agreement and filing: No physician agreement required.

Alaska APRN licensing and prescribing requirements

Arizona Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Board prescribing authority required.
Agreement and filing: No physician agreement required.

Arizona advanced practice and prescribing requirements

Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in Arizona and structures the agreement and oversight their state requires.

Arkansas Physician Collaboration Requirements

AANP practice category: Reduced practice
Physician collaboration required: Required for prescribing unless full independent practice authority is approved.
Path to independent practice: Available after qualifying experience and state approval.
Prescribing: Collaborative or independent, depending on authorization.
Agreement and filing: Collaborative agreement until independent authority is approved.

Arkansas full independent practice rules | Arkansas advanced practice requirements

California Physician Collaboration Requirements

AANP practice category: Restricted practice
Physician collaboration required: Generally required unless authorized to practice without standardized procedures.
Path to independent practice: Available through Board certification; eligibility and setting restrictions apply.
Prescribing: Furnishing authority and controlled substance rules apply.
Agreement and filing: Standardized procedures unless exempt under Board certification.

California NP pathways under AB 890

Colorado Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No physician specifically required; prescribing mentorship generally applies.
Path to independent practice: Independent practice permitted; prescribing has separate transition requirements.
Prescribing: Full prescribing authority generally follows a required mentorship.
Agreement and filing: Written prescribing mentorship with a qualified physician or APRN.

Colorado nursing rules including prescriptive authority

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Connecticut Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: Yes, during the initial transition.
Path to independent practice: Available after required experience and notice to the state.
Prescribing: Written prescribing collaboration during the transition.
Agreement and filing: Maintain the agreement; notify the state before independent practice.

Connecticut APRN collaboration and independent practice

Delaware Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Prescriptive authority accompanies the APRN license.
Agreement and filing: No physician agreement required.

Delaware Nursing Practice Act sections 1902 and 1935

Florida Physician Collaboration Requirements

AANP practice category: Restricted practice
Physician collaboration required: Yes, unless registered for autonomous practice within its authorized scope.
Path to independent practice: Available to eligible NPs for primary care.
Prescribing: Protocol-based unless autonomous; controlled substance limits apply.
Agreement and filing: Physician protocol or autonomous practice registration required.

Florida autonomous practice requirements | Florida APRN practice and prescribing

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Georgia Physician Collaboration Requirements

AANP practice category: Restricted practice
Physician collaboration required: Yes, for delegated medical acts and prescribing.
Path to independent practice: No general pathway.
Prescribing: Protocol-based; controlled substance limits apply.
Agreement and filing: Nurse protocol agreement registered with the Medical Board.

Georgia nurse protocol registration

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Hawaii Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Board prescriptive authority required.
Agreement and filing: No physician agreement required.

Hawaii APRN prescriptive authority

Idaho Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Within NP scope and required prescribing authority.
Agreement and filing: No physician agreement required.

Idaho nursing practice rules

Illinois Physician Collaboration Requirements

AANP practice category: Reduced practice
Physician collaboration required: Generally required until full practice authority is granted.
Path to independent practice: Available after required experience, education and state authorization.
Prescribing: Some controlled substances still require physician consultation.
Agreement and filing: Written agreement unless full practice authority or a setting exemption applies.

Illinois full practice authority and prescribing

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Indiana Physician Collaboration Requirements

AANP practice category: Reduced practice
Physician collaboration required: Yes, for prescribing.
Path to independent practice: No general pathway to independent prescribing.
Prescribing: Requires Board prescriptive authority and physician collaboration.
Agreement and filing: File a written agreement for prescriptive authority.

Indiana APRN prescriptive authority requirements

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Iowa Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Within NP scope and required prescribing authority.
Agreement and filing: No physician agreement required.

Iowa ARNP role and scope

Kansas Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Within NP scope and required prescribing authority.
Agreement and filing: No physician agreement required.

Kansas APRN practice regulations

Kentucky Physician Collaboration Requirements

AANP practice category: Reduced practice
Physician collaboration required: Required for prescribing unless the applicable exemption is met.
Path to independent practice: Prescribing agreement exemptions are available after qualifying experience.
Prescribing: Separate agreement rules for noncontrolled and controlled drugs.
Agreement and filing: Maintain prescribing agreements until properly discontinued or exempted.

Kentucky APRN prescribing agreements and exemptions

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Louisiana Physician Collaboration Requirements

AANP practice category: Reduced practice
Physician collaboration required: Required for medical diagnosis and prescribing; a dentist may qualify.
Path to independent practice: No general pathway.
Prescribing: Within the approved collaborative practice.
Agreement and filing: Written collaborative agreement and Nursing Board approval required.

Louisiana Boards joint statement on collaboration

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Maine Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: Initial supervision required; a qualified NP may serve instead.
Path to independent practice: Available after the required supervised practice period.
Prescribing: Within NP scope and prescribing requirements.
Agreement and filing: Register supervision and document its completion with the Board.

Maine APRN supervision and prescribing guidance

Maryland Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No physician specifically required; an initial physician or NP mentor applies.
Path to independent practice: Independent practice permitted with initial mentorship requirements.
Prescribing: Within NP scope and prescribing requirements.
Agreement and filing: New NPs identify a mentor when applying for certification.

Maryland NP certification and mentorship requirements

Massachusetts Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: Initial prescribing supervision required; a qualified NP may serve instead.
Path to independent practice: Independent prescribing available after qualifying experience.
Prescribing: Supervised until independent prescriptive practice requirements are met.
Agreement and filing: Prescribing guidelines during transition; attest and update registration for independence.

Massachusetts APRN prescriptive authority requirements

Michigan Physician Collaboration Requirements

AANP practice category: Restricted practice
Physician collaboration required: Physician delegation required for controlled substance prescribing.
Path to independent practice: No general pathway to independent controlled substance prescribing.
Prescribing: Noncontrolled drugs without delegation; controlled drugs require delegation.
Agreement and filing: Written physician authorization for controlled substance prescribing.

Michigan APRN prescribing statute | Michigan physician delegation rules

Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in Michigan and structures the agreement and oversight their state requires.

Minnesota Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: Initial collaboration required; a qualified APRN may serve instead.
Path to independent practice: Available after required collaborative practice experience.
Prescribing: Within NP scope and prescribing requirements.
Agreement and filing: Transition agreement and completion evidence; setting rules vary by specialty.

Minnesota APRN practice changes effective August 2026

Mississippi Physician Collaboration Requirements

AANP practice category: Reduced practice
Physician collaboration required: Yes.
Path to independent practice: No general pathway.
Prescribing: Within collaborative protocols and prescribing requirements.
Agreement and filing: Maintain protocols and register the collaboration with the Medical Board.

Mississippi APRN collaboration requirements

Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in Mississippi and structures the agreement and oversight their state requires.

Missouri Physician Collaboration Requirements

AANP practice category: Restricted practice
Physician collaboration required: Yes, for delegated medical acts and prescribing.
Path to independent practice: No general pathway.
Prescribing: Physician-delegated; controlled substance limits apply.
Agreement and filing: Written collaborative arrangement and required Board reporting.

Missouri collaborative practice requirements

Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in Missouri and structures the agreement and oversight their state requires.

Montana Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Board prescriptive authority endorsement required.
Agreement and filing: No physician agreement required.

Montana APRN licensing and prescribing requirements

Nebraska Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: Initial collaboration required; a qualified NP may serve instead.
Path to independent practice: Available after required transition experience.
Prescribing: Within NP scope and prescribing requirements.
Agreement and filing: Written transition agreement or evidence of qualifying experience submitted to DHHS.

Nebraska transition to practice agreement

Nevada Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: Required for Schedule II prescribing before the experience threshold is met.
Path to independent practice: Independent practice permitted; Schedule II prescribing has an experience threshold.
Prescribing: Schedule II requires qualifying experience or a physician protocol.
Agreement and filing: Physician protocol for Schedule II prescribing when required.

Nevada Schedule II prescribing protocol and experience threshold

New Hampshire Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Within NP scope and required prescribing authority.
Agreement and filing: No physician agreement required.

New Hampshire APRN scope of practice

New Jersey Physician Collaboration Requirements

AANP practice category: Reduced practice
Physician collaboration required: Required for prescribing unless an exemption applies.
Path to independent practice: Available to eligible primary or behavioral health APNs; excludes general obstetrics and elective aesthetics.
Prescribing: Independent when exemption requirements are met; otherwise joint protocol.
Agreement and filing: Joint protocol unless exempt; independent practice reporting requirements apply.

New Jersey enacted APN practice law

New Mexico Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Prescribing authorization required; training or preceptorship requirements apply.
Agreement and filing: No physician agreement required.

New Mexico CNP licensing | New Mexico APRN prescribing requirements

New York Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: Yes, during the initial practice period.
Path to independent practice: Available after required NP practice experience.
Prescribing: Within NP specialty and prescribing requirements.
Agreement and filing: Written agreement and protocols during the initial practice period.

New York NP practice requirements

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North Carolina Physician Collaboration Requirements

AANP practice category: Restricted practice
Physician collaboration required: Yes.
Path to independent practice: No general pathway.
Prescribing: Under the collaborative agreement and prescribing requirements.
Agreement and filing: Signed agreement and approval to practice required.

North Carolina NP collaborative practice requirements

Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in North Carolina and structures the agreement and oversight their state requires.

North Dakota Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Board prescriptive authority required.
Agreement and filing: No physician agreement required.

North Dakota APRN licensing and prescribing

Ohio Physician Collaboration Requirements

AANP practice category: Reduced practice
Physician collaboration required: Physician or podiatrist collaboration required.
Path to independent practice: No general pathway.
Prescribing: Under a Standard Care Arrangement and prescribing requirements.
Agreement and filing: Maintain the arrangement and report the collaborating provider.

Ohio Standard Care Arrangement requirements

Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in Ohio and structures the agreement and oversight their state requires.

Oklahoma Physician Collaboration Requirements

AANP practice category: Restricted practice
Physician collaboration required: Required for prescribing unless independent authority is approved.
Path to independent practice: Independent prescribing available after qualifying experience and Board approval.
Prescribing: Supervised or approved independent prescribing; drug limits remain.
Agreement and filing: Supervision agreement until independent prescriptive authority is approved.

Oklahoma independent prescribing guidance

Oregon Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Within NP scope and required prescribing authority.
Agreement and filing: No physician agreement required.

Oregon NP scope of practice

Pennsylvania Physician Collaboration Requirements

AANP practice category: Reduced practice
Physician collaboration required: Yes, for medical diagnosis, treatment and prescribing.
Path to independent practice: No general pathway.
Prescribing: Board prescriptive approval and physician collaboration required.
Agreement and filing: Maintain practice agreement; file the prescribing agreement.

Pennsylvania CRNP practice requirements | Pennsylvania prescribing agreement requirements

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Rhode Island Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Within NP scope and required prescribing authority.
Agreement and filing: No physician agreement required.

Rhode Island APRN practice rules

South Carolina Physician Collaboration Requirements

AANP practice category: Restricted practice
Physician collaboration required: Yes.
Path to independent practice: No general pathway.
Prescribing: Agreement-based; controlled substance limits apply.
Agreement and filing: Written practice agreement required.

South Carolina practice agreement guidance | South Carolina prescribing requirements

Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in South Carolina and structures the agreement and oversight their state requires.

South Dakota Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: Initial collaboration required; a qualified NP or nurse midwife may serve instead.
Path to independent practice: Available after required collaborative practice experience.
Prescribing: Within NP scope and prescribing requirements.
Agreement and filing: Board-approved transition agreement until qualifying hours are verified.

South Dakota NP licensing and transition agreement

Tennessee Physician Collaboration Requirements

AANP practice category: Restricted practice
Physician collaboration required: Physician or qualified podiatrist supervision required.
Path to independent practice: No general pathway.
Prescribing: Protocol-based with required prescribing authorization.
Agreement and filing: Maintain written protocols and required supervision documentation.

Tennessee supervision and protocol requirements

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Texas Physician Collaboration Requirements

AANP practice category: Restricted practice
Physician collaboration required: Yes, for medical aspects of care and prescribing.
Path to independent practice: No general pathway.
Prescribing: Physician-delegated; Schedule II authority is limited.
Agreement and filing: Prescribing agreement or qualifying facility protocol; register delegation.

Texas APRN practice and delegation requirements

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Utah Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Within NP scope and required prescribing authority.
Agreement and filing: No physician agreement required.

Utah Nurse Practice Act

Vermont Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: Initial collaboration required; a qualified APRN may serve instead.
Path to independent practice: Available after transition requirements for the role and population focus.
Prescribing: Within NP scope and prescribing requirements.
Agreement and filing: Signed transition agreement; notify the Board when requirements are met.

Vermont transition to practice requirements

Virginia Physician Collaboration Requirements

AANP practice category: Restricted practice
Physician collaboration required: Yes, unless authorized for autonomous practice.
Path to independent practice: Available after qualifying experience and Board authorization.
Prescribing: Under practice agreement or autonomous practice rules.
Agreement and filing: Written practice agreement until autonomous authorization.

Virginia autonomous practice requirements

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Washington Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Board prescriptive authority required.
Agreement and filing: No physician agreement required.

Washington advanced nursing practice and prescribing

West Virginia Physician Collaboration Requirements

AANP practice category: Reduced practice
Physician collaboration required: Required for prescribing until independent authority is granted.
Path to independent practice: Independent prescribing available after qualifying experience and Board approval.
Prescribing: Collaborative or approved independent prescribing; drug limits remain.
Agreement and filing: File collaboration verification until independent prescribing is approved.

West Virginia prescribing collaboration and exemptions | West Virginia prescribing limits

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Wisconsin Physician Collaboration Requirements

AANP practice category: Reduced practice
Physician collaboration required: Physician or dentist collaboration required unless independent practice is approved.
Path to independent practice: Available after qualifying experience and Board verification.
Prescribing: Requires prescriptive eligibility; controlled substance rules apply.
Agreement and filing: Document collaboration or obtain Board approval for independent practice.

Wisconsin APRN independent practice implementation

Wyoming Physician Collaboration Requirements

AANP practice category: Full practice
Physician collaboration required: No.
Path to independent practice: Independent at licensure.
Prescribing: Within NP scope and required prescribing authority.
Agreement and filing: No physician agreement required.

Wyoming nursing practice guidance

Frequently Asked Questions

Can one physician collaborate across multiple states?

Yes, but only if the physician is properly licensed in each state where collaboration occurs and meets that state’s specific collaboration requirements. Multi-state collaboration is common, but compliance must be assessed state by state.

Can clinics share collaborating physicians across locations?

Sometimes. Many states allow physicians to collaborate with providers across multiple locations, but ratio limits, geographic rules, and supervision expectations may restrict how widely a single physician can be shared.

Can newly licensed providers have different collaboration requirements?

Yes. Many states impose stricter collaboration or supervision requirements on newly licensed Nurse Practitioners, with reduced requirements after completing a defined number of practice hours or years.

Can a physician collaborate with providers in different specialties?

In some states, yes, but others require physicians to collaborate only within their scope of training or specialty. Specialty alignment is especially important in areas like psychiatry, aesthetics, IV therapy, and specialty prescribing.

What is a Collaborative Practice Agreement (CPA)?

A Collaborative Practice Agreement (CPA) is a formal written agreement that outlines the relationship between a physician and a Nurse Practitioner, including scope of practice, prescribing authority, consultation requirements, and quality oversight.

How often do agreements need to be updated?

Update requirements vary by state. Some states specify a renewal interval; agreements should also be reviewed when staffing, scope, prescribing, practice location, or governing rules change.

Is a written physician collaboration agreement always required?

No. In full practice authority states, written collaboration agreements are not required. In collaboration or transitional states, written agreements are often mandatory and must meet specific statutory or board requirements.

Do collaboration agreements need to be filed with the state?

Some states require collaboration agreements to be filed or made available upon request, while others require clinics to retain agreements internally for audit purposes only.

Can a collaboration agreement be terminated early?

Yes. Most collaboration agreements can be terminated early, but states may require notice periods, transition plans, or immediate cessation of certain services if no replacement collaboration is in place.

Are collaboration agreements subject to audit?

Yes. State boards and regulatory agencies may audit collaboration agreements during investigations, complaints, license renewals, payer audits, or corporate transactions.

Can providers prescribe independently under a collaboration agreement?

Sometimes. Prescriptive authority under a collaboration agreement depends on state law and the terms of the agreement. Many states limit controlled substance prescribing or require additional oversight.

Can collaborating physicians restrict what medications a provider can prescribe?

Yes. Collaboration agreements often define or limit prescribing authority beyond what state law requires, especially for controlled substances or specialty medications.

Does physician collaboration impact DEA registration?

It can. DEA registration must align with state scope-of-practice rules and collaboration requirements. Improper collaboration arrangements can create DEA compliance risks.

Who is responsible for ensuring collaboration compliance: the provider or the organization?

Both. Individual providers are responsible for practicing within their legal scope, while clinics and organizations are responsible for structuring compliant collaboration, documentation, and oversight systems.

What happens if collaboration requirements aren’t met?

Failure to comply can result in license discipline, fines, prescribing restrictions, payer clawbacks, contract termination, or forced clinic closure, depending on severity and state enforcement posture.

Who enforces physician collaboration laws?

Enforcement typically involves state nursing boards, medical boards, and sometimes departments of health or attorneys general, depending on the issue.

Manage Physician Collaboration Across States

GuardianMD helps clinics and multi-location organizations coordinate collaborating physicians, state-specific agreements, license and ratio tracking, and audit-ready documentation.

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