Florida nurse practitioners have had a path to autonomous practice since 2020, but that authority has only ever covered primary care. Outside of family medicine, general pediatrics, and general internal medicine, including most med spa and aesthetic work, a collaborating physician is still legally required. The 2026 legislative session considered bills to expand that scope. All of them died before reaching the governor’s desk.

What Autonomous Practice Actually Covers

Florida’s autonomous practice law, codified at 2025 Florida Statutes 464.0123, lets a qualifying APRN treat patients without a physician’s written protocol. That authority does not extend to an NP’s full scope of training. It is limited to primary care: family medicine, general pediatrics, and general internal medicine, along with the acts already permitted for certified nurse midwives.

An autonomous APRN can order medications, admit and discharge patients in certain licensed facilities, and sign documents the law otherwise reserves for a physician, including death certificates, within that primary care scope. The one procedural limit written into the statute itself: an autonomous APRN cannot perform a surgical procedure other than a subcutaneous one.

Outside primary care, none of that changes. An NP practicing psychiatry, dermatology, anesthesia, or aesthetic medicine still needs a physician’s protocol, no matter how long they have held autonomous registration.

NPs weighing whether autonomous status is enough to run their own practice should also review how it interacts with opening an independent practice in Florida. Ownership rules and practice authority rules are governed by separate statutes.

Autonomous Practice Registration Requirements

Meeting the primary care definition does not automatically grant autonomous status. An APRN must apply to the Florida Board of Nursing and satisfy separate requirements before registration is approved. Missing any one of them means practicing under a standard collaborative agreement instead.

• Active license: An active, unencumbered Florida APRN license or a multistate license recognized under the Nurse Licensure Compact.
• Clean disciplinary record: No disciplinary action on record within the preceding five years.
• Clinical hours: At least 3,000 supervised clinical practice hours completed within the five years before applying, under a licensed MD or DO.
• Coursework: Three graduate-level semester hours, or the equivalent, in differential diagnosis, and three in pharmacology, completed within that same five-year window.
• Financial responsibility: Proof of malpractice coverage in the amount the Board requires.
• Registration renewal: Registration with the Board of Nursing is renewed every two years alongside APRN licensure.

As of early 2026, 14,601 APRNs held autonomous practice registration in Florida, including 1,802 psychiatric nurses, according to Department of Health data cited in the House’s bill analysis of HB 301. That is a small share of the state’s roughly 66,600 licensed APRNs, since most NPs outside primary care have no reason to register for an authority their specialty cannot use. Non-autonomous NPs and those weighing whether to register can see how the two tracks differ in this Florida NP scope-of-practice guide.

Why Med Spa NPs Still Need a Collaborative Agreement

Aesthetic medicine falls outside Florida’s statutory definition of primary care, so an NP’s autonomous registration does not authorize it. Every med spa NP, regardless of registration status or hours logged, needs a collaborative agreement under the 2025 Florida Statutes 464.012. Cosmetic and dermatologic work carries an added requirement that most collaborating physicians don’t meet.

• Services affected: Injectables, laser treatments, hormone therapy, and IV hydration all fall outside primary care.
• Governing statute: Fla. Stat. 464.012 requires a collaborative agreement regardless of autonomous registration status.
• Physician qualification: The collaborating physician must be a dermatologist, a plastic surgeon, or trained in the specific procedures the NP performs.
• Compliance structure: Practices offering both primary care and aesthetic services need two separate agreements, not one.

Treating the two compliance tracks as interchangeable is one of the fastest ways a med spa ends up facing a Board of Nursing complaint or a Health Care Clinic Act violation.

What the 2026 Legislative Session Tried to Change

The 2026 legislative session ran from January 13 to March 13 and considered two bills that would have expanded autonomous practice beyond primary care. Both targeted different specialties but shared the same outcome. Neither survived committee before the session closed.

• HB 693: The HB 693 bill would have authorized autonomous practice for all APRN specialties, and it died in Senate Rules on March 13, 2026.
• HB 301 / SB 138: HB 301 and its Senate companion, SB 138, would have allowed autonomous psychiatric nurses to practice mental health services without a physician protocol, and they died in Health Policy the same day.

With both bills dead, the collaborative agreement requirement outside primary care carries into 2026 unchanged from where it stood in 2020.

Full Practice vs. Reduced Practice vs. Restricted Practice: Where Florida Stands

State nurse practice laws sort into three tiers based on how much physician involvement they require. Roughly 30 states now grant full practice authority in some form, but Florida is not among them. Florida’s status instead depends entirely on what specialty the NP practices.

• Full practice: NPs evaluate, diagnose, treat, and prescribe without any physician agreement required.
• Reduced practice: A physician relationship is required for at least one element of the NP’s practice.
• Restricted practice: Physician supervision is required across the entire scope of practice.
• Florida’s position: Reduced practice for family medicine, pediatrics, and internal medicine NPs, restricted practice for every other specialty, including med spa and aesthetic medicine.

An NP moving from a full practice state shouldn’t assume Florida’s autonomous law works the same way outside primary care. This breakdown of full, reduced, and restricted practice authority covers how the categories apply state by state.

How Medical Director Co. Supports Florida NPs Who Need a Collaborating Physician

Medical Director Co.’s collaborating physician services place Florida NPs with a collaborating physician within 24 hours, backed by an attorney-reviewed agreement built for the NP’s specialty, whether that is a primary care practice operating outside autonomous registration, a med spa, or a hormone therapy clinic. The flat monthly rate is $799, with no separate setup fee and no long-term contract.