Last updated: October 14, 2026.
This is general information, not legal advice and not a scope-of-practice opinion for a specific patient. Your national certification and the patient’s state both limit what you may do. Confirm both before you open a specialty service or take a telehealth panel.
State practice authority is only one part of a specialty decision. Match the proposed service to your role, population focus, education, certification, and competence, then check the state’s setting and procedure rules. A general NP practice map cannot establish permission for every specialty service.
The state categories are on NP full practice authority states (2026). The vocabulary is in what is an autonomous nurse practitioner?.
Why population focus matters
National certification is issued in a population focus: family, adult-gerontology, pediatrics, psychiatric-mental health, women’s health, neonatal, and others. State boards license or certify you in that focus. Practicing outside it is a discipline risk even in a full-practice state.
New Jersey wrote the point into statute in 2026. P.L.2026, c.6 lets an APN drop the joint protocol only if the APN is authorized in family or individual-across-the-lifespan, adult-gerontology, pediatrics, women’s health, or behavioral health, has more than 5,000 hours in that focus, and is providing primary or behavioral health care. General obstetrics and elective aesthetic or cosmetic services are excluded. A certification that is not on that list does not become eligible because the clinic is in New Jersey. Details are in New Jersey’s 2026 APN law.
Psychiatric-mental health NPs
A PMHNP’s independent practice depends on the patient’s state, not on a separate PMHNP compact.
- In a full-practice state, a PMHNP who holds that state’s APRN authorization can assess, diagnose, and prescribe within the psychiatric-mental health focus without a career-long physician agreement, subject to any transition hours.
- In a reduced or restricted state, check the required relationship and any individual exemption; a conditional pathway may cover some clinicians or services. Controlled substances add a DEA registration and any state CSR.
- Telepsychiatry follows the patient’s location. A multistate RN license does not cover it. See telehealth licensing.
New Jersey’s behavioral-health focus is one of the five foci in the 2026 exemption, with a duty to arrange a higher level of care when the documented assessment says the patient needs it. That is not the same sentence as “all PMHNPs in New Jersey are independent on the day they are certified.” The 5,000-hour test still applies.
Florida’s autonomous APRN registration is limited to primary care, including family medicine, general pediatrics, and general internal medicine, as defined by board rule. Do not read that statute as authorization for a full autonomous psychiatry practice. Florida remains restricted practice on the AANP May 2026 map. See Florida autonomous APRN registration.
Texas is restricted practice as well. Prescribing is delegated by a physician through a prescriptive authority agreement. Schedule II prescribing is limited to hospital facility-based care, for a patient admitted for an intended stay of at least 24 hours or treated in that hospital’s emergency department, and to hospice. Texas does not require a Department of Public Safety controlled-substance registration. That registration ended September 1, 2016. A federal DEA registration is still required for controlled substances. See Texas nursing license by endorsement.
Family and adult-gerontology NPs
FNPs and adult-gerontology primary care NPs commonly provide primary care. In full-practice states they are the clinicians the “open your own practice” question is usually about. The checklist of NPI, DEA, malpractice, and payer enrollment is in can a nurse practitioner open their own practice?.
Adult-gerontology splits into primary care and acute care. The patient’s needs and acuity, together with the clinician’s preparation, determine whether the work fits; the building alone does not. Primary-care NPs may work in hospitals in appropriate roles, and acute-care NPs may work in outpatient settings. A second certificate or extra training may be needed when the proposed care falls outside the existing role. Check the board’s scope guidance and facility privileges.
Connecticut’s transition, three years and 2,000 collaboration hours, applies to APRNs as a class, including FNPs and AGNPs, before they practice without a collaborating physician. The hour rule is not specialty-specific in the DPH statement.
New York uses one hour figure for every certified specialty. An NP needs more than 3,600 hours of qualifying NP practice before the written practice agreement and protocols drop. Education Law §6902, in the text the State Education Department posts, marks that rule effective until July 1, 2030. The endorsement guide is New York nursing license by endorsement.
Wound care and aesthetics
Wound care is a service line, not a population focus of its own on the AANP map. A wound-care NP’s authority is the authority of their certification plus the state category.
- An FNP or AGNP in a full-practice state may provide wound care that sits inside that certification and the state’s scope rules.
- In a restricted state, check whether the work requires a supervisory relationship or is covered by an individual exemption.
- If the work crosses into a procedure the statute reserves, the practice category does not waive the procedure limit. Florida’s autonomous registration, for example, bars surgical procedures other than subcutaneous procedures.
Elective aesthetics are more restricted than the map suggests. New Jersey’s 2026 exemption expressly excludes elective aesthetic or cosmetic services. An APN who qualifies for independent primary care or behavioral health does not, under that statute, drop the joint protocol for an elective aesthetics practice. Other states regulate lasers, injectables, and ownership of medical spas through the medical board or a separate rule. Those rules are not collected in the AANP practice map. Read them before you advertise a med spa.
How to read a state for your specialty
| Question | Where the answer lives |
|---|---|
| Is the state full, reduced, or restricted for NPs? | AANP map and the state list |
| Does my certification match the service? | Your certifying body’s population focus and the state board’s recognized specialties |
| Is there a transition or hour rule? | The state statute. Confirmed examples are in the practice-opening article |
| Did the state carve out a service? | The statute. New Jersey carves out general obstetrics and elective aesthetics. Florida’s autonomous path carves practice down to primary care |
| Can I do this by video? | Patient’s state APRN license, plus DEA rules if you prescribe controlled substances |
| What may I prescribe? | Prescribing roadmap |
For California, verify whether the service and setting fit an approved 103 or 104 NP certification. For New Jersey, check that the service fits the statutory exemption. These individual checks are more useful than applying one nationwide specialty count.
Example: assessing a proposed wound-care service
Start with the actual patient group and procedures. An adult-gerontology credential does not by itself cover a pediatric panel. A wound certificate can document focused education, but it does not replace APRN licensure or change a population focus. Determine whether the proposed debridement, prescribing, or other procedure fits state scope and the clinician’s training; obtain facility privileges where applicable.
Next, check independent-practice conditions for that service. A Florida registration limited to primary care does not establish that every standalone specialty clinic qualifies. A New Jersey exemption for primary or behavioral care does not extend to elective aesthetics. Document the scope decision, referral thresholds, and coverage before advertising the service.
Frequently asked questions
Which states let a PMHNP practice independently?
The full-practice states and the District of Columbia on the May 2026 AANP map, if you hold that state’s psychiatric-mental health authorization and you have finished any transition hours. Reduced and restricted states require a separate check of physician-agreement rules and individual exemptions. New Jersey adds a behavioral-health path under P.L.2026, c.6 for APNs who meet the hour test.
Can a wound-care NP practice independently?
Only to the extent an NP with that certification can practice independently in that state, and only for wound care inside the certification. Check procedure limits separately.
Does Florida’s autonomous registration cover psychiatry or wound care?
The statute limits autonomous practice, other than the nurse-midwife path, to primary care as the Board defines it. Confirm with the Board before you treat a non-primary-care specialty as included.
Are AGNPs and FNPs treated differently on the AANP map?
No. The map is not split by specialty. The difference is certification, transition hours, and any statutory carve-out.
Sources
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AANP State Practice Environment, May 2026.
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New Jersey P.L.2026, c.6, population foci and the aesthetics and obstetrics exclusions.
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Florida Statutes § 464.0123, primary-care limit and the subcutaneous-procedure limit.
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NYSED, NP practice requirements and Education Law §6902, more than 3,600 hours until July 1, 2030.
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Texas BON, APRN practice FAQ, including primary-care preparation and practice in acute-care settings.