Nurse entrepreneurship Starting a nurse-owned business
Startup guide
Starting a nurse-owned business
The structure decides the licenses. A nurse working alone may fall inside a state’s individual exemption; a business that sends other nurses into homes usually does not; a business that subcontracts to a licensed agency may sit under that agency’s license.
Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.
Last reviewed October 17, 2026. 18 findings: 7 verified, 11 provisional. 2 time-sensitive, flagged with a recheck date. How findings are sourced and labelled.
1Three ways to organize the work
State by state: compare the states or open the map layers for elective IV hydration, the home-care license and sole-practitioner exemption, RN PICC insertion and NP practice environment.
Working alone
VerifiedSeveral states exempt an individual nurse from agency licensure only while she acts alone: Texas exempts an RN or LVN “who provides home health services as a sole practitioner” (HSC §142.003(a)(2)); Florida exempts a licensed nurse, “whether or not incorporated”, who is “acting alone” (§400.464(6)(c)); Colorado excludes an individual “who acts alone, without employees or contractors”.
Recheck on the official site. Texas and Colorado were read on verbatim mirrors; confirm on the official sites.
Source: HSC §142.003 (public.law mirror)Fla. Stat. §400.464C.R.S. §25-27.5-102 (public.law mirror)
Employing or contracting other nurses
ProvisionalEmploying or contracting other nurses removes the individual exemption in every state where its wording was read (“acting alone”, “sole practitioner”, “solely … his own services”, “without employees or contractors”, “independently and not through any contractual or employment relationship”). In Texas the business then needs an HCSSA license whether the second nurse is an employee or a 1099 contractor; Texas has not published guidance defining “sole practitioner”.
Not yet confirmed — check with the state licensing agency (in Texas, HHSC Long-Term Care Regulation).
Source: HSC §142.003 (public.law mirror)Fla. Stat. §400.464Minn. Stat. §144A.471N.C.G.S. §131E-136C.R.S. §25-27.5-102 (public.law mirror)
Some states exempt a business that works only through a licensed agency. Texas exempts “a person who provides one health service through a contract with a person licensed under this chapter” (§142.003(a)(7)); Washington does not regulate “a person who provides services through a contract with a licensed agency” (RCW 70.127.040(5)); Minnesota excludes independent contractors who work only for licensed providers and have no direct client agreements (§144A.471, subd. 9).
Recheck on the official site. Texas was read on a verbatim mirror; confirm on the official site.
Source: HSC §142.003 (public.law mirror)RCW 70.127.040Minn. Stat. §144A.471
In Illinois, Missouri, the District of Columbia, Washington and West Virginia, the home health agency definition needs nursing plus at least one other service, so a nursing-only business falls outside it; adding therapy, aide or social services brings it in. Washington lets a nursing-only business elect to be licensed.
Recheck on the official site. Illinois was read on a mirror; confirm on the official site.
Source: 210 ILCS 55/2.04 (ILGA mirror)RSMo §197.400D.C. Code §44-501RCW 70.127.010W. Va. Code §16-2D-2
2Forming the entity
Which entity a nurse may use is set by each state’s professional corporation and LLC statutes. No authoritative 50-state survey of nurse-owned entities was found.
The North Carolina Board of Nursing says an RN may establish an independent professional nursing business, professional corporation or professional limited liability company, and that LPNs may not own professional nursing businesses in full or in part; the statement lists G.S. §55B-14 among its references.
Corrected 2026-10-18: G.S. §55B-14 is now cited as one of the statement’s references, not beside the LPN sentence.
Source: NCBON position statement: IV hydration, nutrient therapies and medications
California: a nursing corporation
ProvisionalCalifornia nurses use a professional nursing corporation (Bus. & Prof. Code §2775 ff.); California LLCs cannot render licensed professional services. Nurses may be minority shareholders in a medical corporation, which physicians must majority-own (Corp. Code §13401.5).
Not yet confirmed — check with the California Secretary of State and the Board of Registered Nursing.
Source: EliteNP: nurse practitioner business entities (reader thread)
New York: same-profession ownership
ProvisionalNew York professional corporations and PLLCs must be owned by licensees in the same profession, so physicians and nurses do not co-own one.
Not yet confirmed — check with the New York Department of State and the Office of the Professions.
Source: EliteNP: nurse practitioner business entities (reader thread)
Texas: NPs do not co-own a medical PLLC
ProvisionalTexas allows jointly owned entities of physicians with PAs, podiatrists and optometrists, not NPs (Tex. Bus. Orgs. Code §301.012); NPs commonly operate a nursing practice through a PLLC or general LLC.
Not yet confirmed — check with the Texas Secretary of State.
Source: EliteNP: nurse practitioner business entities (reader thread)
No 50-state list of nurse entities was found
ProvisionalMost state professional corporation and PLLC acts cover any licensed professional service, which would include nursing, but whether a nurse must use a professional entity, and who may co-own it, was not verified state by state. A paid 50-state survey of corporate practice exists.
Not yet confirmed — check with the state licensing agency and the secretary of state.
Source: EliteNP: nurse practitioner business entities (reader thread)Epstein Becker Green: Corporate Practice of Medicine, a 50-state survey (AHLA)
3Corporate practice of medicine and MSOs
The nursing business is one thing; the medical service that orders IV therapy is another.
States most often called strict
ProvisionalSecondary sources most often name California, New York, Texas, Washington, Colorado and Iowa as strict corporate-practice-of-medicine states; they conflict on Illinois. This is a characterization by law firms, not a statutory list.
Not yet confirmed — check with the state licensing agency and the secretary of state.
Source: Cohen Healthcare Law: corporate practice of medicineHarris Sliwoski: the strictest corporate practice of medicine states (2021)
The MSO pattern
ProvisionalWhere a lay or nurse owner cannot employ the prescriber, the common pattern is a management services organization that handles non-clinical functions and contracts with a physician-owned (or, where allowed, NP-owned) professional entity, with fixed or cost-plus fees rather than a percentage of revenue.
Not yet confirmed — check with the state licensing agency and the secretary of state.
Source: AmSpa: who can own a medical spa (MSOs)Prospyr: CPOM compliance for multi-state med spas
Ohio’s boards: “Regardless of the ownership structure … neither the business nor the business owner is permitted to exercise any control over the way physicians and other health care professionals provide medical, nursing, or pharmacy services.” Alabama and South Carolina require the business to employ a prescriber who exercises exclusive authority over diagnosis and prescribing.
Source: Ohio medical, pharmacy and nursing boards: joint regulatory statement on retail IV therapy clinics (May 15, 2025)Alabama Board of Medical Examiners: declaratory ruling on retail IV therapy (July 21, 2022)South Carolina joint advisory opinion: retail IV therapy businesses (Aug 15, 2023)
The Georgia Composite Medical Board reads O.C.G.A. §43-34-25(n) to bar a supervising physician from receiving “compensation of any kind … from an APRN or an APRN-owned company”.
Source: Georgia Composite Medical Board: IV hydration/therapy position statement (May 7, 2026)
RIDOH: licensees may form a professional service corporation to avoid facility licensure, but at least one owner must be able to perform the services offered, and leasing the corporation to a management company is treated as a sham. RIDOH’s example of an all-nurse corporation that needs a physician, PA or CNP owner concerns Botox; that the same reasoning applies to an IV business is this guide’s reading, not RIDOH’s statement.
Not yet confirmed — check with the Rhode Island Department of Health.
Corrected 2026-10-18: RIDOH’s all-nurse corporation example concerns Botox, not IV therapy; its application to IV businesses is now marked as a reading and the finding is Provisional.
Source: RIDOH: guidance on medical spas and IV therapy businesses (July 2024)
4Employees, contractors and families
IRS Publication 926 lists private nurses as household workers. Social Security and Medicare taxes apply at $3,000 or more in cash wages in 2026, and federal unemployment tax at $1,000 or more in any quarter. A worker supplied and controlled by an agency is not the family’s employee.
Time-sensitive. Thresholds change each year.
Source: IRS Publication 926 (2026), Household Employer’s Tax Guide
Federal contractor classification is in flux
ProvisionalSince May 1, 2025, the Department of Labor has not applied its 2024 independent-contractor rule in investigations, using its 2008 Fact Sheet #13 approach; the 2024 rule remains for private litigation. DOL proposed rescinding the 2024 rule in a notice published February 27, 2026 (91 FR 9932), with comments closing April 28, 2026; no final rule was found as of October 17, 2026.
Not yet confirmed — check with the U.S. Department of Labor, Wage and Hour Division.
Time-sensitive. A final rule on the February 2026 proposal may issue; recheck the Federal Register.
Corrected 2026-10-18: Added DOL’s February 27, 2026 proposed rescission of the 2024 rule (not final).
Source: Duane Morris: DOL guidance on the 2024 independent contractor rule (May 2025)U.S. Department of Labor: news release on the proposed rescission of the 2024 independent contractor rule (Feb 26, 2026; published in the Federal Register Feb 27, 2026)
California applies the ABC test to nurses
ProvisionalCalifornia’s AB 5 exempts physicians and certain other professions but not RNs, NPs or LVNs, so nurse contractors are tested under the ABC test.
Not yet confirmed — check with the California Labor Commissioner or the Employment Development Department.
Source: Hooper Lundy: California AB 5 and health care workers
5Safety obligations of an employer
Bloodborne pathogens
ProvisionalOSHA’s bloodborne pathogens standard (29 CFR 1910.1030) applies to employers whose staff have occupational exposure: an exposure control plan, a hepatitis B vaccination offer and safety-engineered sharps. Medical waste and sharps disposal are regulated by state agencies.
Not yet confirmed — check with OSHA (the federal standard) and, for medical waste, the state environmental or health agency.
Official sources
- HSC §142.003 (public.law mirror)
- Fla. Stat. §400.464
- C.R.S. §25-27.5-102 (public.law mirror)
- Minn. Stat. §144A.471
- N.C.G.S. §131E-136
- RCW 70.127.040
- 210 ILCS 55/2.04 (ILGA mirror)
- RSMo §197.400
- D.C. Code §44-501
- RCW 70.127.010
- W. Va. Code §16-2D-2
- NCBON position statement: IV hydration, nutrient therapies and medications
- EliteNP: nurse practitioner business entities (reader thread)
- Epstein Becker Green: Corporate Practice of Medicine, a 50-state survey (AHLA)
- Cohen Healthcare Law: corporate practice of medicine
- Harris Sliwoski: the strictest corporate practice of medicine states (2021)
- AmSpa: who can own a medical spa (MSOs)
- Prospyr: CPOM compliance for multi-state med spas
- Ohio medical, pharmacy and nursing boards: joint regulatory statement on retail IV therapy clinics (May 15, 2025)
- Alabama Board of Medical Examiners: declaratory ruling on retail IV therapy (July 21, 2022)
- South Carolina joint advisory opinion: retail IV therapy businesses (Aug 15, 2023)
- Georgia Composite Medical Board: IV hydration/therapy position statement (May 7, 2026)
- RIDOH: guidance on medical spas and IV therapy businesses (July 2024)
- IRS Publication 926 (2026), Household Employer’s Tax Guide
- Duane Morris: DOL guidance on the 2024 independent contractor rule (May 2025)
- U.S. Department of Labor: news release on the proposed rescission of the 2024 independent contractor rule (Feb 26, 2026; published in the Federal Register Feb 27, 2026)
- Hooper Lundy: California AB 5 and health care workers
- eCFR: 29 CFR 1910.1030 (bloodborne pathogens)
Revision history
| Date | Change |
|---|---|
| 2026-10-17 | First published |
About this guide. Published and maintained by Paloma Health Technologies; Findings are cited to official sources, dated and status-labelled; see the editorial policy. Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.
Questions
Starting a nurse-owned business: common questions
Does forming a PLLC or LLC change whether I need an agency license?
Not by itself. Florida’s exemption applies “whether or not incorporated”; in Texas the exemption names “a registered nurse”, and how HHSC treats an entity has not been published. What changes the answer in the states read is employing or contracting other nurses.
Can a nurse-owned company employ the doctor who signs IV orders?
In strict corporate-practice states generally not; the common pattern is a physician-owned professional entity under contract. Several boards also bar the business from controlling clinical judgment.