The scope of practice for a nurse practitioner in Florida depends on which of two pathways you work under: a written supervisory protocol with a physician or dentist, which is the default for most of the state’s roughly 65,000 licensed ARNPs, or autonomous registration under Section 464.0123, which about 13,470 practitioners hold. Each pathway defines what you can diagnose, prescribe, sign, and own, and the differences are sharper than many practitioners assume.
The Two Practice Pathways
Every Advanced Practice Registered Nurse in Florida starts out practicing under a written protocol with a Florida-licensed physician or dentist. That protocol is the legal source of your clinical authority. It lists the specific medical acts you’re authorized to perform, and your scope must align with the supervising practitioner’s specialty area.1Florida Board of Nursing. ARNP Protocol Format
The supervising physician doesn’t have to be onsite, but must be reachable by phone or another communication device when away. A copy of the protocol has to be kept at every location where you practice. In group practices, you need a supervisory protocol with at least one physician in the group; the group may designate one physician to sign on behalf of others.1Florida Board of Nursing. ARNP Protocol Format The physician (not you) must notify the Board of Medicine that the supervisory relationship exists.
Autonomous practice, effective since January 1, 2019, lets qualifying ARNPs work in primary care without any protocol. It expands authority in specific ways but narrows the clinical settings where you can use it.
What You Can Do Under a Physician Protocol
Within the boundaries the protocol sets, you can take health histories, perform physical assessments, order diagnostic tests including lab work and imaging, diagnose health problems, and plan treatment with the patient. You can initiate referrals and coordinate ongoing care.1Florida Board of Nursing. ARNP Protocol Format
You can start, adjust, or discontinue therapies for uncomplicated acute illnesses and manage stable chronic conditions. What you can’t do is exceed the protocol. If it covers family practice, you’re limited to the conditions and treatments it lists. Treating outside that scope is practicing beyond your legal authority, and the Board of Nursing treats it as a disciplinable offense.
One boundary catches protocol-based ARNPs off guard: you cannot sign death certificates or certify a cause of death. That authority sits with physicians, physician assistants, and ARNPs registered for autonomous practice.
What Autonomous Practice Adds, and What It Doesn’t
Autonomous ARNPs are limited to primary care, which Florida defines as family medicine, general pediatrics, and general internal medicine. Certified nurse midwives who register as autonomous can also provide midwifery services, though out-of-hospital intrapartum care requires a written patient transfer policy for emergencies.
Inside that primary care lane, autonomous registration unlocks two authorities protocol-based NPs don’t have. You can admit patients to healthcare facilities, manage their inpatient care, and discharge them, unless federal law or rule prohibits it. And you can provide signatures, certifications, and verifications that would otherwise require a physician’s sign-off, which includes filing death certificates and certifying cause of death.
Two firm limits still apply. Autonomous ARNPs cannot perform any surgical procedure beyond subcutaneous procedures. And they cannot issue physician certifications for medical marijuana under Section 381.986, which restricts that authority to MDs and DOs licensed under Chapters 458 or 459.2Florida Senate. Florida Statutes 381.986 – Medical Use of Marijuana
Prescribing Limits
ARNPs working under a protocol can prescribe, dispense, and order any drug authorized in that protocol, including controlled substances listed under Chapter 893, provided they hold a graduate degree covering specialized practitioner training and a federal DEA registration.3Justia. Florida Code 464.012 – Licensure of Advanced Practice Registered Nurses But several caps apply regardless of pathway.
Schedule II drugs are capped at a 7-day supply. The only exception is a psychiatric nurse, as defined in Section 394.455, prescribing psychiatric medications within a protocol established with a psychiatrist.4Florida Senate. Florida Statutes 464.012 – Licensure of Advanced Practice Registered Nurses
Acute pain opioids are tighter still. Florida Administrative Code Rule 64B9-4.017 sets a 3-day default supply limit for Schedule II opioids prescribed for acute pain. Any deviation requires documented clinical justification in the patient’s record.5Legal Information Institute (LII) / Cornell Law School. Fla Admin Code Ann R 64B9-4.017 – Standards for the Prescribing of Controlled Substances for the Treatment of Acute Pain Practitioners aware of the statutory 7-day cap sometimes miss that the administrative rule tightens it further for acute pain opioids.
Psychiatric controlled substances for patients under 18 can only be prescribed by ARNPs who are also certified psychiatric nurses.4Florida Senate. Florida Statutes 464.012 – Licensure of Advanced Practice Registered Nurses
Pain management clinics are off-limits for ARNP controlled substance prescribing. The law prohibits ARNPs from prescribing controlled substances in registered pain management clinics.
Medical marijuana certification is closed to ARNPs entirely, including those with autonomous registration. Section 381.986 reserves that authority for qualified physicians holding active, unrestricted MD or DO licenses.2Florida Senate. Florida Statutes 381.986 – Medical Use of Marijuana
Qualifying for Autonomous Registration
To register as an autonomous ARNP, you need at least 3,000 hours of clinical practice under a supervisory protocol and a clean disciplinary record for the preceding five years. You also need 3 graduate-level semester hours in differential diagnosis and 3 graduate-level semester hours in pharmacology, both completed within the past five years.6Justia. Florida Code 464.0123 – Autonomous Practice by an Advanced Practice Registered Nurse
Autonomous registration triggers a financial responsibility requirement that protocol-based ARNPs don’t face. You must carry professional liability coverage of at least $100,000 per claim with a $300,000 annual aggregate, or maintain an irrevocable letter of credit in those same amounts. The coverage can come from an authorized insurer, a surplus lines insurer, a risk retention group, or the Joint Underwriting Association.7Florida Board of Nursing. Board of Nursing Financial Responsibility Protocol-based ARNPs aren’t statutorily required to carry malpractice coverage, though annual premiums for NP professional liability typically run between roughly $800 and $2,100 depending on specialty.
Autonomous ARNPs also take on 10 hours of approved graduate-level coursework per renewal cycle on top of the standard CE.8Florida Board of Nursing. Continuing Education Requirements
Owning a Clinic
Florida law lets ARNPs own medical clinics. Under Section 400.9905, a clinic staffed by licensed health care practitioners can qualify for an exemption from separate clinic licensure if it’s wholly owned by one or more licensed practitioners or their immediate family members. At least one owner who is a licensed practitioner must supervise the business activities and bear legal responsibility for the entity’s compliance with federal and state laws.9Florida Senate. Florida Code 400.9905 – Definitions
An ARNP can own and operate a clinic without a physician co-owner, provided the ownership and supervision structure meets the statute. For autonomous ARNPs offering primary care, this opens a path to full practice independence, though separate licensing and billing requirements outside Chapter 464 still apply.
Penalties for Practicing Outside Your Scope
The Board of Nursing has broad authority to discipline ARNPs who exceed their legal scope or violate protocol requirements. Penalties escalate sharply from first to second offense.
For practicing beyond your authorized scope or failing to meet minimum standards of acceptable nursing practice, a first offense ranges from a reprimand with a $250 fine and mandatory continuing education up to a $500 fine with probation. A second offense ranges from a reprimand with a $750 fine and suspension up to license revocation.10Legal Information Institute (LII) / Cornell Law School. Fla Admin Code Ann R 64B9-8.006 – Disciplinary Guidelines, Range of Penalties, Aggravating and Mitigating Circumstances
For violating a board rule or failing to meet a legal obligation, such as practicing without a proper protocol, a first offense can range from a letter of concern with a $100 fine and continuing education up to a $250 fine with probation. A second offense ranges from a reprimand with a $500 fine and suspension up to a $750 fine and revocation.10Legal Information Institute (LII) / Cornell Law School. Fla Admin Code Ann R 64B9-8.006 – Disciplinary Guidelines, Range of Penalties, Aggravating and Mitigating Circumstances
The board can also suspend a license until a personal appearance, place a practitioner on supervised probation, or require professional treatment. Aggravating factors like patient harm or a pattern of violations push penalties toward the maximum. The fines are the small part. Suspension and revocation are what end careers.