Nurse Practitioner Form NP-CR Collaborative Relationships 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name exactly as it appears on your New York State Education Department issued nurse practitioner registration certificate.
3. Next, provide your nurse practitioner registration number(s) in the designated field.
4. Identify your specialty area(s) of practice from the provided list, ensuring you select all that apply.
5. Initial in the section confirming you have over 3,600 hours of qualifying experience as a nurse practitioner.
6. Initial again to attest that you maintain collaborative relationships with licensed physicians or hospitals as required.
7. List the names and license numbers of physicians with whom you have collaborative relationships, including any relevant hospital information.
8. Optionally, provide any additional information regarding your collaborative relationships in the space provided.
9. Finally, sign and date the form to complete your attestation before saving or submitting it through our platform.

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