Anesthesiologist Assistant Licensure

Attention Applicant

Pursuant to NRS 630.167, as part of the application process, you are required to submit to a criminal background investigation. Upon receipt of your completed application, your License Specialist will send you an authorization form, the appropriate fingerprint cards, and instructions. 

Forms

Anesthesiologist Assistant Application for Licensure
Use this link to apply online for licensure as an anesthesiologist assistant in the State of Nevada.
Application Checklist - Anesthesiologist Assistant Application
Form 1 - Anesthesiologist Assistant Application
Education Verification
Form 2 - Anesthesiologist Assistant Application
NCCAA Certification
Form 3 - Anesthesiologist Assistant Application
Verification of State Licensure
Form 4 - Anesthesiologist Assistant Application
Malpractice Claim Verification
Form 5 - Anesthesiologist Assistant Application
Hospital Privileges Verification
Form A - Anesthesiologist Assistant Application
Release
Form B - Anesthesiologist Assistant Application
List of Malpractice Insurance Carriers
Form C - Anesthesiologist Assistant Application
Form C - Anesthesiologist Assistant Military Endorsement Application
Civil Applicant Waiver - Anesthesiologist Assistant Application
Responsibility Statement - Anesthesiologist Assistant Application
Anesthesiologist Assistant Application - Military Endorsement
Use this form to apply for expedited license by endorsement to practice as an Anesthesiologist Assistant for U.S. Armed Forces active members, spouses of U.S. Armed Forces active members, veterans and spouses / surviving spouses of veterans. Please see Form C - Anesthesiologist Assistant Military Endorsement Application - here:  Form C.
Anesthesiologist Assistant Simultaneous Licensure Application
Use this form to apply for a license to practice as an Anesthesiologist Assistant in the State of Nevada if you are simultaneously applying for Anesthesiologist Assistant licensure with the Nevada State Board of Osteopathic Medicine.

General Forms

Address Change Form
Name Change Form
Certification of Identification
License Verification Request Form
Replacement Wall Certificate Order Form
Fingerprint Instructions
Petition for Review of Criminal History