Thank you so much for this bill, it will truly help more patients receive care in the state of Virginia. I have one request/comment. There are many routes for Nurse Practitioners to practice, the career like medicine has many specialties and flexibility. For nurse practitioners that are certified and licensed in more than one specialty does it really have to be a 5 year obligation to practice in both specializations before being allowed autonomous practice? For example if a nurse practitioner has over 5 years in one specialty area, and then becomes certified and licensed in another specialty area but does not have the full five years of practice in that area does he/she still have to complete 5 years in both specialties before applying for autonomous practice? -- or does that provider apply for autonomous practice for one specialty that they qualify for and then complete the five years and apply for autonomous practice in their next specialty? How will this work for providers that have been granted autonomous practice and then return to school to become licensed and certified in another specialty? Last question, once a provider becomes autonomous how will this affect if the are trained and learn a new procedure, ie transmagnetic stimulation, will that provider have to contact their referring team physician for practice hours?

Thank you for this opportunity for clarification.