Yes, nurse practitioners can practice independently in Maryland. A 2015 state law gave NPs full practice authority, which means you can evaluate patients, diagnose, order and interpret tests, prescribe medications, and manage treatment on your own, without a physician collaboration agreement. Getting to that independent practice, though, involves certification, a mentorship period for first-time NPs, prescribing registrations, and the ordinary business setup any solo clinician has to handle.
What Independent Practice Actually Covers
Maryland became a full practice authority state on October 1, 2015, when the Nurse Practitioner Full Practice Authority Act took effect. The law redefined “practice as a nurse practitioner” to mean independently conducting physical assessments, establishing medical diagnoses, ordering and interpreting lab tests, prescribing drugs, performing diagnostic and therapeutic measures, and providing emergency care.1Maryland General Assembly. House Bill 999 Chapter 468 – Nurse Practitioner Full Practice Authority Act of 2015
The Maryland Board of Nursing is the sole regulatory authority. No physician board approval or co-signature is required for your clinical decisions. You still consult and collaborate with physicians or other providers when a case calls for it, but that is a matter of professional judgment, not a mandated supervisory arrangement.1Maryland General Assembly. House Bill 999 Chapter 468 – Nurse Practitioner Full Practice Authority Act of 2015
Certification You Need to Hold
Maryland uses “Advanced Practice Registered Nurse” (APRN) as the umbrella term covering certified nurse practitioners (CRNPs), nurse midwives, nurse anesthetists, and clinical nurse specialists.2Cornell Law Institute. Maryland Code Regulations 10.27.05.01 – Definitions To practice as an NP you apply for CRNP certification through the Board of Nursing. Three things must be in place:
- An active Maryland RN license, or a multistate RN license under the Nurse Licensure Compact.
- A graduate degree in advanced practice nursing (MSN or DNP) from an accredited program, with transcript coursework in advanced pharmacology, advanced pathophysiology, and advanced physical assessment.
- Current national certification in your specialty from a Board-recognized certifying body.
The application takes your completed form, proof of RN licensure, an official transcript sent directly from the program, and documentation of national certification.3Board of Nursing – Maryland Department of Health. Criteria for Advanced Practice Certification and Instructions for the Applicant The statutory basis sits in Maryland Health Occupations ยง 8-302.1.4New York Codes, Rules and Regulations. Maryland Health Occupations 8-302.1 – Advanced Practice Certification
The 18-Month Mentorship for New NPs
If you have never been certified as an NP in any state, Maryland requires you to name a mentor before you start practicing. The mentor must be a Maryland-licensed physician or a Maryland-licensed NP who has held their license in good standing for at least three years. The mentorship lasts 18 months from the date of your application.3Board of Nursing – Maryland Department of Health. Criteria for Advanced Practice Certification and Instructions for the Applicant
This is for consultation and collaboration, not supervision. Your mentor does not co-sign your charts or approve your clinical decisions. But you cannot skip the step, and you must list that person on the application. NPs who have already been certified in another state are exempt.
Prescribing on Your Own
Prescribing drugs and devices is part of the NP scope, and Board regulations govern the specifics by specialty.1Maryland General Assembly. House Bill 999 Chapter 468 – Nurse Practitioner Full Practice Authority Act of 2015 Controlled dangerous substances need two additional registrations before you write a single prescription:
- A state CDS registration from the Maryland Office of Controlled Substances Administration. Before OCSA processes your application, you must first register with Maryland’s Prescription Drug Monitoring Program through the CRISP system.5Maryland Department of Health. CDS Application
- A federal DEA registration at $888 for a three-year term, tied to each specific practice location where you prescribe.6Federal Register. Registration and Reregistration Fees for Controlled Substance and List I Chemical Registrants
All DEA-registered practitioners must complete a one-time 8-hour training on treating patients with opioid or other substance use disorders, a federal requirement that took effect with DEA registrations and renewals starting in June 2023. NPs who prescribe CDS also complete a 2-hour course on dispensing and prescribing controlled substances.
You can dispense starter dosages to patients at no charge if the dosage covers 72 hours or less and you record the dispensing in the chart. Broader dispensing authority applies in specific settings like nonprofit clinics, public health facilities, and workers’ compensation clinics.7Maryland General Assembly. Maryland Health Occupations 8-508
Standing Up the Practice as a Business
Full practice authority gives you the legal right to own and run a clinical practice. Turning that right into a functioning business runs through a few layers.
Choosing an Entity
Maryland does not recognize Professional Limited Liability Companies as a distinct entity type for healthcare professionals. Your main options are a standard LLC, a Professional Corporation, or a Professional Association. PCs and PAs carry restrictions: ownership is limited to licensed professionals authorized to render that specific service, and a PC can only provide one type of professional service. A standard LLC offers more flexibility for an NP-owned practice, though you should work with an attorney familiar with Maryland health care entity law to make sure your structure does not run afoul of the corporate practice of medicine doctrine.
NPIs and Payer Enrollment
Every NP needs a Type 1 National Provider Identifier as an individual provider. If you incorporate as an LLC or other entity, that organization also needs its own Type 2 NPI, which requires an Employer Identification Number from the IRS.8Centers for Medicare & Medicaid Services. The Who, What, When, Why and How of NPI The Type 2 application goes through the National Plan and Provider Enumeration System and requires an authorized official and at least one healthcare taxonomy code.9NPPES. NPI Application Help Page
To accept Medicare, you enroll through the Provider Enrollment, Chain, and Ownership System (PECOS). Get your NPI first, then register for login credentials in Identity and Access Management, then complete the PECOS application under the scenario that matches your structure, such as sole proprietor or group member. CMS requires electronic funds transfer for all Medicare payments. After submission, your Medicare Administrative Contractor may request additional documentation, and you have 30 days to respond before the application is delayed or denied.10Centers for Medicare & Medicaid Services. PECOS for Physicians and Non-Physician Practitioners
Private insurance credentialing is separate and often slower. Each insurer has its own application, and some take months. Most NPs start credentialing well before the doors open, because you cannot bill an insurer for patients seen before your credentialing effective date.
Carrying Your Own Liability Insurance
On your own, you carry your own malpractice exposure. No employer’s policy sits behind you. The type of policy matters as much as the limits.
A claims-made policy covers you only if both the incident and the claim occur while the policy is active. If you switch carriers, change jobs, or close the practice, you need tail coverage (an extended reporting endorsement) to stay protected against claims filed later for care during the policy period. Tail coverage is typically a one-time purchase costing 150% to 250% of your annual premium and lasts indefinitely. An occurrence-based policy covers any incident that happened during the policy period regardless of when the claim is filed, so tail coverage is unnecessary.
Claims-made premiums start lower but escalate over several years, and the tail cost at the end can be substantial. Occurrence premiums cost more upfront but stay more predictable.
Keeping Certification and DEA Current
Maryland NP certifications expire on the 28th of your birth month and renew biennially. The CRNP renewal fee is $216, which includes a Maryland Health Care Commission fee and a preceptorship surcharge.11Maryland Department of Health. Schedule of Fees
Maryland does not impose its own state-specific CE hour requirement for APRNs. Instead, you must maintain your national certification, which has its own CE rules. Through the American Nurses Credentialing Center, for example, you need 75 continuing education contact hours per renewal cycle, including 25 hours in pharmacology.12American Nurses Credentialing Center. ANCC Certification Renewal Handbook Other certifying bodies set their own requirements.
Your DEA registration renews on a separate three-year cycle. The DEA no longer mails paper notices; email reminders start 60 days before expiration. Miss the renewal window and you have one calendar month to reinstate. After that month you must apply for a brand-new registration, and you cannot handle any controlled substances during the gap.13Drug Enforcement Administration. Registration
The Self-Employment Tax Picture
Running your own practice makes you self-employed. You owe self-employment tax on net practice earnings of $400 or more, which covers both halves of Social Security and Medicare. The combined rate is 15.3%: 12.4% for Social Security and 2.9% for Medicare.14Internal Revenue Service. Self-Employment Tax (Social Security and Medicare Taxes)
The Social Security portion applies only to the first $184,500 of combined earnings in 2026.15Social Security Administration. Contribution and Benefit Base The Medicare portion has no cap. If your net self-employment income tops $200,000 ($250,000 if married filing jointly), you owe an additional 0.9% Medicare surtax on the amount above that threshold.14Internal Revenue Service. Self-Employment Tax (Social Security and Medicare Taxes)
You will file a Schedule SE with your annual return and should make quarterly estimated payments to avoid underpayment penalties. New practice owners often underestimate the first-year bill because they are used to seeing only the employee half of payroll taxes on a W-2. The self-employed version doubles it.
HIPAA Is on You Now
As an independent practice owner, you are a HIPAA-covered entity. You are personally responsible for the administrative, physical, and technical safeguards the Security Rule requires. HHS publishes guidance tailored for small providers on access controls, encryption, and workforce training.16HHS.gov. Security Rule Guidance Material
No single federal law dictates exactly how long you must retain patient records, but HIPAA requires you to safeguard them for as long as you keep them. Maryland has its own retention standards, and malpractice statutes of limitation effectively set a practical floor. Most practice consultants recommend retaining adult records for at least ten years after the last encounter, and longer for pediatric records. Building a records system correctly at the start is far easier than retrofitting one with hundreds of active charts already in it.