NP · Puerto Rico
Supervision Agreement for Nurse Practitioners in Puerto Rico
Yes, a written supervising-physician agreement is required. Puerto Rico calls it a Written Collaborative Agreement.
Ley 254-2015 Art. 2(b)/(e)(2) says advanced practice nurses 'puede[n] funcionar de manera independiente' and may hold private practice, but every NP task involving diagnosis, orders, or prescribing must be 'previamente discutid[o]' or run through 'protocolos y acuerdos colaborativos con el médico' — no experience-based exit exists. AANP classifies PR 'Reduced Practice.'
What the supervision must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
Not codified — left to the agreement
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
No PR statute was found expressly requiring individual DEA registration for NPs, unlike NC/VA — this may be addressed only in Board of Nursing regulations not reviewed in this pass.
Written agreement
Required
Unconditional for the diagnostic/treatment/prescribing functions that define NP practice — Ley 254-2015 gates every one of them on a collaborative protocol/agreement with the patient's physician, even though the same statute recognizes NPs' right to own an independent nursing-practice business.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Corporación Profesional under Ley 164-2009, Cap. 238 (14 L.P.R.A. §§3921–3938) — stockholders/incorporators must be licensed to provide the professional service named in the certificate of incorporation. Ley 254-2015 Art. 2(b) separately recognizes an APRN's right to establish independent private practice, unlike the PA entry above.
Unlike PAs, nothing in Ley 254-2015 or Ley 164-2009 was found barring an APRN from independently owning a nursing-services professional corporation.
What a supervising physician costs here
Typical monthly cost in Puerto Rico
$500 – $700
Estimate for one Nurse Practitioner. This state's rules add a restrictive-tier premium.
About Puerto Rico's rules
PR's 'Médico Asistente' (PA) credential is NOT the mainland PA profession — it is a bridge pathway mainly for internationally-trained physicians awaiting PR licensure (Ley 71-2017), capped at 2 per supervising physician with zero prescriptive authority. APRNs (NP/CNM/CRNA/CNS) need patient-level collaborative protocols with a physician for nearly all diagnostic/prescriptive functions (Ley 254-2015) despite AANP rating PR 'Reduced Practice.' No dedicated esthetician license currently exists.
Other clinicians in Puerto Rico: see the state overview.