Florida VFC Provider Profile/Update

Thank you for your Provider Profile Form!

Note: Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.

A copy of this application has been sent to the email address you listed in the form. Please print and sign a copy of that email and maintain in your records. (Some email providers filter messages based on content, subject line, or the sender's address and may put your email into the a spam or junk mail folder. Please make sure FloridaVFC@FLHealth.gov is on your "approved sender" list or "whitelist" and/or in your "address book.")

The Provider Reenrollment Form is the provider's agreement to comply with all the conditions of the VFC Program. This form must be signed and submitted annually. The medical director or equivalent in a group practice with many providers must sign the Provider Recertification Form for the entire group. All other providers within the practice must be listed on the Provider List Section.