Name changes require legal documentation showing the name change. Please submit a request including your full name as it appears on your license, profession, license number, your new name, your date of birth, the last four digits of your social security number, and your signature. Attach supporting documents, which must be one of the following:
- a copy of a state issued marriage license that includes the original signature and seal from the clerk of the court
- a divorce decree restoring your maiden name
- a court order showing the name change.
Any one of these will be accepted unless the Department has a question about the authenticity of the document. If you wish to receive a new license that reflects the name change, you must request a duplicate license.
Mail your $25.00 payment and request to:Division of Medical Quality Assurance, P.O. Box 6320 Tallahassee FL 32314-6320
If you need to change your name, and you prefer to renew online, please submit your name change request by mail and allow 5-7 business days processing time before you renew online.