Change of Address Notice - Licensed Clinics
Fee $25 (New)
A license is valid only for the licensee, provider and location for which the license is issued. A new license will not be issued for the new location until a change of address application is received and approved by the agency. You must report a facility's change of location to the agency within 21 calendar days from the effective date of the change, as required by s. 408.810 (3), Florida Statutes.
To request a change of address, select the link below and complete ONLY Sections 1A, 1B, 2, & 10 of the application. Attach a copy of your current Health Care Clinic License.
Fee - A $25 fee applies. Make check or money order payable to AHCA. The agency does not accept starter checks.
APPLICATION AND INSTRUCTIONS (AHCA Form 3110-0013 Revised)
