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New Jersey Board of Nursing

(as it appears on your license certificate) 
(as it appears on your license certificate) 
(i.e. CCXXXXX, MZXXXXX, DIXXXXXX) The two-letter prefix is found on your license certificate and precedes your six-digit license number.) 
(i.e. AI001200, AS089890, DI019980) The six-digit license number is found on your license certificate after the two-letter prefix.) 
 
 
 
 
 
 
 
 
(if not U.S.A.) 
 
(if applicable) 
 
 
 
 
(if not U.S.A.) 
Note: If your mailing address is a business or practice location, you must provide the business or practice name in order to ensure mail delivery.
 
(if applicable) 
 
 
 
 
(if not U.S.A.) 
Note: If your mailing address is a business or practice location, you must provide the business or practice name in order to ensure mail delivery.
 
 
 
 
 
(if not U.S.A.) 
Last Modified: 9/7/2016 1:32 PM