Licensure Certification Form
(Make check or money order payable to the appropriate licensing board.)
If you are requesting that your exam scores be submitted with your request for certification, please complete and forward the attached form with your request for certification. Please be aware that most states do not require exam scores, please check with the licensing authority prior to requesting this information.
Division of Medical Quality Assurance
Licensure Support Services
Attn: License Verifications
P.O. Box 6320
Tallahassee, FL 32314-6320