How to Start an NP Practice in Pennsylvania: CRNP Designation, Act 44, and the 4-CRNP Limit
By Jody Mitchell, MD | July 15, 2025
A family practice NP outside Philadelphia called me in a panic. She had been seeing patients for two weeks in her new clinic before she realized her collaborative agreement had never been filed with the State Board of Nursing. In Pennsylvania, that is not a paperwork oversight -- it is a compliance violation. The collaborative agreement must be filed with the Board before you practice. She had to stop seeing patients, file the agreement, and wait for confirmation. It cost her three weeks of revenue and a lot of sleepless nights.
A family practice NP outside Philadelphia called me in a panic. She had been seeing patients for two weeks in her new clinic before she realized her collaborative agreement had never been filed with the State Board of Nursing. In Pennsylvania, that is not a paperwork oversight -- it is a compliance violation. The collaborative agreement must be filed with the Board before you practice. She had to stop seeing patients, file the agreement, and wait for confirmation. It cost her three weeks of revenue and a lot of sleepless nights.
Pennsylvania is a reduced practice state with its own terminology and its own set of rules that differ meaningfully from neighboring states. NPs here are called Certified Registered Nurse Practitioners (CRNPs), and the practice framework was substantially updated by Act 44 of 2007. If you are planning to open a practice in Pennsylvania, Act 44 is the statute you need to understand inside and out.
I have helped NP colleagues navigate the Pennsylvania framework in Philadelphia, Pittsburgh, the Lehigh Valley, and several rural communities where provider shortages create enormous demand. The state has a large, diverse healthcare market with real opportunity -- but the regulatory details are specific, and getting them wrong costs time and money.
The CRNP Designation and Pennsylvania's Practice Framework
Pennsylvania uses the title Certified Registered Nurse Practitioner (CRNP) -- not APRN, not NP. This is not just a naming convention. The CRNP designation carries specific legal meaning under the Pennsylvania Professional Nursing Law and the Medical Practice Act, and using the wrong title on official documents can cause processing delays.
Act 44 of 2007 was the landmark legislation that defined the modern CRNP practice framework. Under Act 44, CRNPs can: