Fill in Your California Fnp 004 Template

The California FNP 004 form is a critical document for medical practitioners operating under a fictitious name in the state. This form serves multiple purposes, primarily focusing on the renewal of a fictitious name permit and the notification of any changes related to ownership or practice address. Practitioners must provide essential information, including their current physical practice address, the fictitious name under which they operate, and their FNP number. Additionally, the form requires the submission of a renewal fee and mandates that any changes in ownership, such as the addition or removal of partners or shareholders, be documented with appropriate signatures. It's important to note that a fictitious name permit is non-transferable, meaning that if a practice changes hands, the previous owner must cancel the existing permit while the new owner must apply for a new one. This ensures that the name remains available and compliant with state regulations. The form also includes a declaration section, where the individual completing it attests to the accuracy of the information provided under penalty of perjury. Understanding the nuances of the FNP 004 form is essential for maintaining compliance and ensuring the smooth operation of a medical practice in California.