Regulations

NP Collaborating Physician Proximity Requirements: 50 State Guide

Chris Turitzin
June 17, 2026
5 mins
Updated:
June 17, 2026

TABLE OF CONTENTS

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Example H2

Many NP collaborating physician arrangements can operate through phone calls, video, EHR access, and scheduled check-ins. But that does not always mean the physician can be located anywhere.

Some states still regulate where the collaborating physician practices, whether the physician must visit a practice site, or how close the physician must be in certain settings. South Carolina, for example, focuses on whether the physician is actively practicing in the state; Tennessee and Nevada focus more directly on site visits or onsite time.

The table below summarizes NP/APRN proximity, distance, in-state, onsite, and in-person collaboration requirements by state, including Washington, DC.

Key Highlights
  • 40 jurisdictions do not set a specific NP/APRN collaborating physician proximity requirement.
  • 6 states have an in-state requirement: Arkansas, Colorado, Georgia, Louisiana, Mississippi, and South Carolina.
  • 3 states have an on-site requirement: Alabama, Nevada, and Tennessee.
  • 2 states have conditional proximity requirements: Florida and Missouri.

‍

How Proximity Rules Work In Practice

For a physician considering NP collaboration, the first question is not only whether you can be available by phone, video, or EHR. It is whether your own location, practice pattern, or visit obligations make you eligible to serve in that state.

In-State Requirement

In these states, licensure may not be enough. The rule may also look at where you actively practice. South Carolina requires the collaborating physician to be actively practicing in South Carolina.41 In Georgia, the physician must be Georgia-licensed and either practice in Georgia or, if principally practicing outside Georgia, practice within 50 miles of the state line.11

If you hold a license in the NP's state but practice primarily somewhere else, confirm that your practice location still qualifies before signing the agreement.

On-Site Requirement

Some collaborations require more than remote availability. Alabama, Nevada, and Tennessee each create some form of physician presence, onsite time, or remote-site visit obligation.12943

Before agreeing to serve, make sure the arrangement accounts for the required visits: how often they must occur, which locations are covered, how the visit is documented, and what happens if you are unavailable.

Conditional Proximity Requirement

Some rules only apply in specific settings or service lines. Florida's proximity rule is tied to offices primarily providing dermatologic or skin care services, while Missouri has different rules for rural health clinics, federally qualified health centers, correctional centers, and certain other settings.1026

For these states, do not stop at the headline rule. Confirm whether the proximity requirement applies to the services, setting, and location involved in the collaboration.

No Proximity Requirement

Most jurisdictions do not set a fixed NP/APRN proximity, distance, in-state, onsite, or in-person collaboration requirement. That usually gives the physician and NP more flexibility, but it does not remove the need for clear expectations around availability, consultation, escalation, coverage, and documentation. Those expectations often connect to other oversight duties, including chart review and collaborating physician meeting requirements.

Collaborating Physician Proximity Requirements By State

NP/APRN collaborating physician proximity requirements by state
State Category Summary Notes
Alabama On-site requirement Physician presence and remote-site visits are required in some CRNP collaborations. Lower-experience CRNP collaborations require physician presence for at least 10% of scheduled hours; remote practice sites need at least two visits each year.1
Alaska No proximity requirement2    
Arizona No proximity requirement3    
Arkansas In-state requirement Physician must actively practice in Arkansas or a contiguous border county. The physician must be Arkansas-licensed. Contact may occur by radio, telephone, electronic, or other telecommunication device, so this is not an onsite or in-person collaboration rule.4
California No proximity requirement5    
Colorado In-state requirement Prescriptive authority mentors must actively practice in Colorado. This applies to the prescriptive authority mentorship relationship. Colorado APRNs otherwise practice independently, and mentorship communication may occur remotely if it is synchronous.6
Connecticut No proximity requirement   Initial collaboration must still cover consultation, referral, coverage, outcome review, disclosure, and certain prescribing terms.7
Delaware No proximity requirement8    
District of Columbia No proximity requirement9    
Florida Conditional proximity requirement Certain dermatology and skin-care offices must be within 25 miles or a contiguous county. The rule applies to offices without onsite physician supervision and includes a 75-mile cap. Protocols must be kept onsite at each APRN practice location.10
Georgia In-state requirement Physician must be Georgia-licensed and practice in Georgia or within 50 miles. Georgia also requires annual onsite observation and quarterly record review. The nurse protocol must state when direct onsite physician evaluation or consultation is required.11
Hawaii No proximity requirement12    
Idaho No proximity requirement13    
Illinois No proximity requirement14    
Indiana No proximity requirement Agreement must address geographic proximity, but no mileage or onsite rule is set.15  
Iowa No proximity requirement16    
Kansas No proximity requirement17    
Kentucky No proximity requirement18    
Louisiana In-state requirement Collaborating physician must actively provide patient care in Louisiana. The physician's practice must be the same as, or comparable in scope, specialty, or expertise to, the APRN's practice. Retired physicians and physicians not consistently providing patient care cannot serve; locum tenens physicians may serve while providing care in Louisiana.19
Maine No proximity requirement20    
Maryland No proximity requirement21    
Massachusetts No proximity requirement22    
Michigan No proximity requirement23    
Minnesota No proximity requirement24    
Mississippi In-state requirement Physician must practice in Mississippi at least 20 hours weekly or 80 hours monthly. Telemedicine and chart review do not count toward the in-state practice threshold. Collaborations more than 75 miles away trigger extended-mileage review unless a primary-care exception applies. Quarterly face-to-face QI meetings are required.25
Missouri Conditional proximity requirement Collaborative practice arrangements must address geographic proximity. Telehealth can waive the proximity requirement if the arrangement outlines telehealth use. Some clinical contexts require physician presence at least every two weeks unless telehealth satisfies the rule.26
Montana No proximity requirement27    
Nebraska No proximity requirement28    
Nevada On-site requirement Physician must practice medicine in Nevada and spend monthly time at APRN service locations. Telephone consultation is allowed, but it does not replace the monthly location requirement or direct-observation component.29
New Hampshire No proximity requirement30    
New Jersey No proximity requirement31    
New Mexico No proximity requirement32    
New York No proximity requirement33    
North Carolina No proximity requirement34    
North Dakota No proximity requirement35    
Ohio No proximity requirement36    
Oklahoma No proximity requirement37    
Oregon No proximity requirement38    
Pennsylvania No proximity requirement Physician must be immediately available by direct communication or telecommunication. Physical onsite presence is not required. The prescribing agreement must state when and how often the physician personally sees patients.39
Rhode Island No proximity requirement40    
South Carolina In-state requirement Collaborating physician must be actively practicing in South Carolina. The state does not set fixed mileage, onsite, or in-person meeting requirements.41
South Dakota No proximity requirement42    
Tennessee On-site requirement Remote sites need physician visits at least every 30 days. At least two required annual remote-site visits must be in person; up to ten may be electronic. General NP supervision does not require continuous physician presence.43
Texas No proximity requirement   Physician physical presence is not required at all times. Monthly prescriptive-authority meetings may occur in a manner determined by the parties.44
Utah No proximity requirement45    
Vermont No proximity requirement46    
Virginia No proximity requirement47    
Washington No proximity requirement48    
West Virginia No proximity requirement   Board guidance says annual collaborative-agreement review should be face-to-face and documented, and treats geography and consultation ability as supervision considerations.49
Wisconsin No proximity requirement50    
Wyoming No proximity requirement51    

Frequently Asked Questions

Does My State Require My Collaborating Physician To Be Nearby?

Most jurisdictions do not set a fixed mileage, on-site, or in-person proximity requirement for NP/APRN collaboration. But some states do regulate where the collaborating physician practices, whether the physician must visit a practice site, or whether a distance rule applies in certain settings.

Examples include Georgia11, South Carolina41, Mississippi25, Tennessee43, and Nevada29.

For physicians, the practical question is whether your license, practice location, and availability satisfy the state rule for the NP relationship you are entering.

Does No Proximity Requirement Mean The Physician Can Be Anywhere?

Only if the physician can still fulfill the requirements of the collaboration. A state may not set a mileage limit or require the physician to be on site, but the physician still needs to be properly licensed, available for consultation, able to review records, able to participate in required meetings, and able to meet any prescribing or agreement obligations.

So the question is not simply where the physician is located. It is whether the physician can realistically do what the state and the agreement require from that location.

Is Communication Availability The Same As Proximity?

No. Availability usually means the physician must be reachable for consultation, referral, escalation, or clinical questions. That can often happen by phone, video, secure message, EHR access, or another agreed communication method.

Proximity is different. A proximity rule says something about location or physical presence, such as where the physician actively practices, whether the physician must visit a site, or whether a practice location must be within a stated distance.

Do Chart Review Or Meeting Rules Count As Proximity Requirements?

Only when the rule creates a physical obligation. A chart review requirement is not a proximity requirement if the review can be completed remotely. A meeting requirement is not an in-person requirement if the rule allows the meeting to happen by phone, video, or another remote method.

The distinction matters because chart review, meetings, consultation, and proximity are separate compliance questions. A state may require chart review without requiring the physician to be nearby, or it may require site visits even when routine communication can happen remotely.

What Should An NP Check Before Signing With A Collaborating Physician?

Before signing, check the regulations of your state. Confirm the physician's license, active practice location, specialty or scope fit, availability obligations, and any required on-site visits, distance limits, or telehealth exceptions.

You should also confirm what the written agreement must say. Some states leave proximity flexible but still require the agreement to address consultation, coverage, escalation, chart review, prescribing, or how the NP and physician will communicate.

Serve As A Collaborating Physician With Clear Requirements

Proximity rules matter because they define whether a physician can actually support the collaboration. In some states, that means being actively practicing in the state. In others, it means being able to complete site visits, maintain availability, or satisfy a setting-specific distance rule.

Single Aim helps physicians evaluate collaboration opportunities with the state-specific requirements in view, so the relationship is built around what the physician can realistically do: availability, documentation, chart review, meetings, prescribing oversight, and any proximity or site-visit obligations. For broader capacity questions, see the separate guide to how many NPs a physician can supervise.

Explore collaborating physician opportunities

Single Aim connects physicians with NP collaboration opportunities and helps clarify state-specific proximity, availability, and oversight expectations before the relationship starts.

Get started with Single Aim


Citations

  1. Ala. Admin. Code r. 610-X-5-.01(12), (15), (16); r. 610-X-5-.09(1), (5), (8), (10).
  2. Alaska Stat. 08.68.850; 12 AAC 44.400-44.445.
  3. A.A.C. R4-19-508(A); Arizona Board of Nursing Scope of Practice Nurse Practitioner/APRN FAQs, updated May 2024.
  4. Ark. Code Ann. 17-87-310, 17-87-314; 060.00.08 Ark. Code R. 002, Regulation 30: Collaborative Practice Agreements; 17 CAR 123-603.
  5. Cal. Bus. & Prof. Code 2836.1, 2837.103, 2837.104; Cal. Code Regs. tit. 16, 1474.
  6. 3 CCR 716-1 Rule 1.14(C)(9), (C)(11), (C)(13)-(15), (C)(24), (G)(2)(a)-(b); C.R.S. 12-255-112(4)(b)(I)(A)-(D).
  7. Conn. Gen. Stat. 20-87a(b)(2), (b)(3); Connecticut DPH APRN practice guidance.
  8. 24 Del. C. 1902(g), 1935(a)-(c); 24 Del. Admin. Code 8.4, 8.6.
  9. D.C. Code 3-1201.02, 3-1206.03; 17 DCMR ch. 59.
  10. Fla. Stat. 458.348(1)(d), (3)(c)(1)-(4); Fla. Stat. 464.012(3).
  11. Georgia Composite Medical Board Rule 360-32-.05(1)-(2); O.C.G.A. 43-34-25(a)(12); Georgia Board of Nursing Rule 410-11-.14(2); Georgia BON protocol FAQ.
  12. Haw. Rev. Stat. 457-8.5, 457-8.6.
  13. Idaho Code tit. 54, ch. 14; IDAPA 24.34.01.
  14. 225 ILCS 60/22(42); 68 Ill. Admin. Code 1285.335(b)(1)-(3); 68 Ill. Admin. Code 1300.430(b)(4).
  15. 848 IAC 5-1-1(a)(7)(D), (F), (G).
  16. Iowa Code 152.1(6); Iowa Admin. Code r. 655-7.2(1), 7.3, 7.4.
  17. K.S.A. 65-1130; Kansas H.B. 2279 (2022).
  18. KRS 314.042(12)(c)-(g), (15)(l)(2)-(3); 201 KAR 20:057 sec. 1(1).
  19. La. Rev. Stat. 37:913(9); La. Admin. Code tit. 46, pt. XLVII, 4505, 4513(D); Louisiana State Board of Nursing and Louisiana State Board of Medical Examiners, Joint Statement of Position, Collaboration and Collaborative Practice (Jan. 2016), https://www.lsbn.state.la.us/joint-practice-statement/.
  20. 02-380 C.M.R. ch. 8 sec. 2(2)(A)-(D); Me. Rev. Stat. tit. 32, 2102(2-A).
  21. Md. Code, Health Occ. 8-302; COMAR 10.27.07.
  22. 243 CMR 2.10(4)(a)-(b), 2.10(5)(b); 244 CMR 4.07.
  23. MCL 333.16109(2)(a)-(c); Mich. Admin. Code R. 338.2411(2)-(4).
  24. Minn. Stat. 148.171, 148.235; Minnesota BON APRN Licensure General Information.
  25. 30 Miss. Admin. Code Pt. 2630, R. 1.2(A), (C)-(E), R. 1.3, R. 1.4, R. 1.5(4), R. 1.8(C); 30 Miss. Admin. Code Pt. 2840, R. 1.1(C), (L)-(M), R. 1.4(C)-(D).
  26. Mo. Rev. Stat. 334.104.3(5), (9); 20 CSR 2200-4.200(2)(H), (3)(A), (3)(F).
  27. Mont. Code Ann. 37-8-202, 37-8-409; ARM 24.159.1406 et seq.
  28. Neb. Rev. Stat. 38-2315, 38-2322; 172 NAC 101.
  29. NAC 630.490(1)(b), (6)-(9), (13); NAC 630.495(1)-(2).
  30. N.H. Rev. Stat. Ann. 326-B:11; N.H. Code Admin. R. Nur 600.
  31. N.J. Admin. Code 13:37-8.1(a)-(c); N.J. Stat. 45:11-49(b)(1).
  32. N.M. Stat. Ann. 61-3-23.2; N.M. Admin. Code 16.12.2.
  33. N.Y. Educ. Law 6902(3)(a)(v), 6902(3)(b); 8 NYCRR 64.5(a)(3).
  34. 21 N.C. Admin. Code 36.0810(1), 36.0810(4)-(5), 36.0816; N.C. Gen. Stat. 90-18.2(a)(5).
  35. N.D. Cent. Code 43-12.1; N.D. Admin. Code 54-05-03.1.
  36. Ohio Rev. Code 4723.01(L)(1), 4723.431(B)(1)-(5); Ohio Admin. Code 4723-8-04(D)(1)-(11).
  37. OAC 435:10-13-2(a)(4), (b); Okla. Stat. tit. 59, 567.4a, 567.4c.
  38. ORS 678.010, 678.390; OAR 851-055-0000, 851-055-0010, 851-055-0070, 851-055-0078.
  39. 49 Pa. Code 21.251, 21.285(a)(4); Pennsylvania Professional Nursing Law sec. 212(13)(i)-(iii).
  40. R.I. Gen. Laws 5-34-3, 5-34-44; 216-RICR-40-05-3.
  41. S.C. Code 40-33-34(C)-(D); South Carolina Board of Nursing and Board of Medical Examiners, Frequently Asked Questions Regarding Implementation of New Law Governing APRN Practice, questions 8, 11, 16 (Sept. 2019).
  42. S.D. Codified Laws 36-9A-12.1, 36-9A-13; S.D. Admin. R. 20:62.
  43. Tenn. Comp. R. & Regs. 0880-06-.02(2), (4), (7)-(9); Tenn. Code Ann. 63-7-123(b)(5)-(6), 63-7-126(f); Tennessee BME FAQ, Physician Supervision of PAs and APNs (Oct. 2016).
  44. Texas BON Prescriptive Authority FAQs; Tex. Occ. Code 157.0512.
  45. Utah Code 58-31b-102(11), 58-31b-803(3)-(4); Utah Admin. Code R156-31b-703b.
  46. 26 V.S.A. 1613(a)(1)-(4); Vermont BON Administrative Rules 9-8, 9-9, 9-10, 9-17.
  47. 18VAC90-30-10, 18VAC90-30-86, 18VAC90-30-120; Va. Code 54.1-2957(D), (I).
  48. RCW 18.79.250; WAC 246-840-300, 246-840-302.
  49. W. Va. Code 30-7-15b(c); W. Va. Code R. 19-8-3.1.f.2; West Virginia Board of Medicine Policy Statement Regarding Minimum Requirements and Guidelines for Physicians in Collaborative Relationships for Prescriptive Authority with APRNs.
  50. Wis. Admin. Code N 8.10(7).
  51. Wyo. Stat. 33-21-120; 054.0002.2 Wyo. Code R. ch. 2.

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Chris Turitzin
Chris, founded Single Aim Health in 2024 to provide clinicians, especially NPs and PAs, with essential services for launching and growing their practices. A Stanford graduate in Product Design, Chris co-founded Momentus Media, which was acquired by Facebook, and worked as a Product Manager there. He later gained expertise in digital health through leadership roles at Bicycle Health, Virta Health, and founding Wink Health. Now, he is using his experience to help clinicians through Single Aim Health.
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Disclaimer: The regulatory research, summaries, and tools provided by Single Aim, LLC are for informational and educational purposes only and do not constitute legal advice. While we strive to ensure accuracy, healthcare laws vary by state and may change over time. You should always consult a licensed attorney familiar with healthcare regulations in your specific state before making decisions related to you clinical and operational needs for compliance. Single Aim is not a law firm and does not provide legal representation. Use of our materials does not create an attorney-client relationship.

Need legal guidance? We recommend contacting a licensed healthcare attorney in your state or using professional associations such as the American Health Law Association (AHLA) or your state’s medical or nursing board for referrals.