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Licensure Information

Individual Licensure Information

Provider Licensure Information

  • Provider Application - All plans and proof of liability insurance must accompany the application.

Online EMS Provider Licensure Application - The electronic renewal process is now active.
Provider Electronic Patient Care Report Agreement - Please make sure you submit this agreement with your application.
EMS Web Management Form - Please make sure you submit this form with your application.
EMS Provider Licensure Application - This form is fillable and should be typewritten, not handwritten. 

  • The following plans are required to be included with your EMS Provider licensure application.

Bio-Hazardous Waste Plan Checklist
Controlled Substance Plan Checklist
EMD Plan Checklist
I.V. Fluid/Drug Plan Checklist

Additional Licensure Information

Last Updated: August 18, 2014

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