Change of Address/Name
All licensees are required by law to keep current home, practice, and email addresses on file with the Board. Licensees should update this information with the Board within 60 days of any changes.
Changing your address
Click on the Online Form link under “Address Change” at right to log in to your Licensure Gateway. Once logged in, you will have the ability to update your address information for both your home or practice address from the home page by clicking the edit icon next to each address.
The following licensee types can update both their home and practice addresses and their email address:
- Physicians
- Physician Assistants
- Anesthesiologist Assistant
- Perfusionists
Note: Residents and Polysomnographic Techs can only update their home address and email address.
Changing your name
Licensees who experience a name change are asked to advise the Board within 30 days of the change. Click on the Online Form link under “Submit a Name Change” at right to begin.
Note: After making changes to your information in the Licensure Gateway, you can print an updated copy of your certificate.
