Name changes require legal documentation showing the name change. To change your name, please submit 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 (adoption, legal name change, federal identity change).
- A copy of a certificate of naturalization or H1B Employment Visa (Note: Foreign applicants and/or licensees may not have state issued documents)
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 request to:
Division of Medical Quality Assurance
Licensure Support Services
P.O. Box 6320
Tallahassee, Florida 32314-6320
For requests by mail, please include 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. Please submit your name change along with supporting document(s) 5-7 business days to allow processing if you need to renew online.
If you do not require a new license to reflect your new name, you may submit your request online or by mail along with legible supporting document(s) to one of the following:
- Log onto your MQA Online Services Portal account , select “Request Name Change” from the “Manage My License” dropdown menu
- Mailing address – DOH, Division of Medical Quality Assurance, Post Office Box 6320, Tallahassee, Florida 32314-6320