Part 1: What California's “104 NP” Actually Means — and What It Doesn't

If you are a nurse practitioner in California, you have probably heard that 2026 is the year you can finally “go independent” — open your own doors, see your own patients, and stop practicing under a physician's standardized procedures. That is partly true. But the headlines have outrun the law, and the gap between “I can practice independently” and “I can build the business I'm imagining” is where most NPs get into trouble.

This series walks through what the new framework actually does, what it leaves untouched, and how to start a practice without stepping on a regulatory landmine. We start at the foundation: what “104 NP” status really is.

Where this comes from: AB 890

The authority everyone is talking about comes from Assembly Bill 890 (Wood, Chapter 265, Statutes of 2020), which Governor Newsom signed in 2020 but which did not take effect until January 1, 2023. It was later amended by SB 1451 (Ashby, Chapter 481, Statutes of 2024), which smoothed out several of the original rules.

AB 890 did not give every NP a new license. It created two new certifications — informally called “103 NP” and “104 NP” — that let qualifying nurse practitioners work without standardized procedures. “Standardized procedures” are the written protocols, signed off by a physician, that traditionally define and authorize what an NP can do. Removing them is the legal core of “independence.” Importantly, AB 890 did not expand the clinical scope of nurse practitioners; it changed the authorization structure around an existing scope.

A key point that is easy to miss: nothing about AB 890 is mandatory. The traditional NP role — practicing under standardized procedures with physician collaboration — remains fully available. 103 and 104 are options, not requirements, and no employer is obligated to use them.

The two tiers: 103 vs. 104

103 NP (Business and Professions Code § 2837.103) lets you practice without standardized procedures, but only inside a defined “group setting” that includes at least one physician and surgeon — a clinic, a licensed health facility, a medical group or professional medical corporation, a home health agency, a hospice, and similar organized settings. In other words, a 103 NP gets clinical independence within someone else's physician-anchored organization. To qualify, you must complete a “transition to practice” of at least three full-time-equivalent years or 4,600 hours of direct patient care in California, within the population focus of your national certification.

104 NP (Business and Professions Code § 2837.104) is the one that unlocks the dream. A 104 NP may practice without standardized procedures outside of a group setting — meaning you are no longer tethered to a physician-led organization. This is the certification that makes a genuinely independent, NP-owned practice legally possible.

But 104 is a second step, not a starting point. Under the Board of Registered Nursing's regulations (16 CCR § 1482.4), you must first work as a 103 NP in good standing for at least three full-time-equivalent years (or 4,600 hours) of direct patient care before you can apply for 104. “Good standing” means an active, unrestricted license with no disciplinary action. (NPs with a Doctor of Nursing Practice may be able to count qualifying direct-patient-care hours from the doctoral portion of their education toward part of this requirement.)

Why 2026 matters

Because 104 status requires three years as a 103 NP, and the Board only began certifying 103 NPs after AB 890's regulations took effect, the math meant the Board literally could not issue any 104 certifications until 2026. That is why this year is the inflection point: California released the 104 NP application in early 2026, and the first cohort of fully independent NPs is coming online now.

If you have not yet completed your 103 transition-to-practice hours, 104 is still on your horizon rather than in your hand. The honest first question for any NP eyeing independence is not “what entity should I form?” — it is “am I actually 104-eligible yet, and can I document it?”

What 104 grants — and what it does not

A 104 NP can:

•       Practice without standardized procedures, outside a group setting.

•       Contract directly with commercial and government payors.

•       Structure employment relationships without a physician-supervision requirement.

•       Join a hospital medical staff consistent with that hospital's bylaws.

What 104 does not do is just as important:

•       It does not expand your clinical scope. You are still limited to the population focus of your national certification — family, adult-gerontology, pediatrics, neonatal, women's health, or psychiatric-mental health — and to the limits of your own education, training, and experience. A family NP does not become a surgeon or a cardiologist by getting 104 certified.

•       It does not eliminate physician involvement entirely. Section 2837.104(c) still requires consultation, collaboration, and referral to physicians and other providers based on the patient's clinical condition — including physician consultation for emergent conditions after initial stabilizing care, and a written referral plan for complex cases and emergencies. (Part 3 covers exactly what kind of physician relationship you still need.)

•       It does not make you a physician. This sounds obvious, but it drives a set of disclosure and advertising rules that trip people up constantly (more on that in Part 2).

One disclosure change worth knowing

SB 1451 simplified the patient-notification rules for 103 and 104 NPs. You must still post a conspicuous notice (in at least 48-point Arial font) stating that nurse practitioners are licensed and regulated by the Board of Registered Nursing, with the Board's phone number and website, and you must verbally tell new patients, in a language they understand, that a nurse practitioner is not a physician and surgeon. SB 1451 removed the older requirements that you also tell patients they have a right to see a physician and that you use specific Spanish-language titles. The disclosure is now leaner — but it is not optional.

The bottom line for Part 1

“104 NP” is real, and it genuinely lets a qualified nurse practitioner own and run an independent practice without a supervising physician. But it is a clinical-authorization change layered on top of a business-law landscape that was not redesigned for it. Independence on the clinical side does not mean independence from California's corporate, licensing, and advertising rules.

In Part 2, we look at the single biggest structural constraint: the Corporate Practice of Medicine doctrine, why your practice must be a nursing corporation rather than a medical corporation, and what that means for how you can name and advertise it.

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This article is for general educational purposes and is not legal advice. The 104 NP framework is new, several adjacent statutes were not written with 104 NPs in mind, and the rules continue to evolve. Consult a qualified California health care attorney before forming an entity or launching a practice.

Key authorities: Cal. Bus. & Prof. Code §§ 2837.101, 2837.103, 2837.104; 16 CCR § 1482.4; AB 890 (2020); SB 1451 (2024); California Board of Registered Nursing, AB 890 resources (rn.ca.gov/practice/ab890.shtml).