Nurse Practitoners — preceptorbridge

Let’s work together

Interested in precepting a nurse practitioner student in return for an honorarium? Fill out some info and we will be in touch shortly! We can't wait to hear from you.

Name

First Name

Last Name

Cell Phone #

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Paste CV/Resume Here

Optional

What kind of provider are you?

Which state are you currently practicing in?

What specialty do you practice in?

Do you consent to receiving text messages for communication purposes?

How many years have you been practicing in your current specialty and role?

What is the name of the place you work and the location?

Please include name of employer.

How many hours do you work per week?

Do you use telemedicine in your practice? If so, how often?

What type of setting you work in?

Have you precepted an NP student before?

What is your highest level of education and certification?

Please include your NPI number:

I understand there is additional verification that may be requested such as copy of license after this form is completed.