Tax for nurse practitioner practices
A CPA for nurse practitioners
NP practices vary more than most: full practice authority in one state, a collaborative agreement in another, and increasingly an aesthetic or telehealth arm that changes the tax picture entirely.
Where this return differs
What is actually different about nurse practitioners at tax time
Not a longer version of the same advice. These are the places this practice type reliably differs from the return next to it.
Collaborative physician fees are a real and recurring expense
Where state law requires a collaborating physician, the fee is an ordinary business expense, but the arrangement needs to be documented as what it is. This is one of the larger line items in a collaborative practice and one of the least well supported.
Telehealth makes state footprint a live question
Multi-state licensure is common, and treating patients in several states can create filing obligations in each. The clinical side is set up to make this easy, which is exactly why the tax side goes unnoticed.
An aesthetic arm adds inventory and possibly sales tax
Injectables and retail skincare are goods, with inventory treatment for income tax and a possible sales tax obligation depending on the state. A practice that adds an aesthetic service line has added a product business.
How it works
What working together looks like
A call first
Thirty minutes to hear what you have and whether this is a fit. If it is not, we will say so and point you somewhere useful.
A written scope and a fixed fee
You get both in writing before work starts, so the return you expected does not arrive with an hourly surprise attached.
Documents through a secure portal
Upload once, in one place, rather than emailing a K-1 with your Social Security number sitting in the attachment.
The questions, while they still matter
Anything that changes your number gets raised when it can still be acted on, not in a footnote after filing.
Then the next twelve months
Estimated payments, an entity change, a new state, a sale. Tax years are consecutive and treating them that way is most of the value.
What this firm does, and what it does not
PizzelloCPA, PLLC is a licensed CPA firm registered with the North Carolina State Board of Certified Public Accountant Examiners as firm no. 35339. It prepares returns and does tax planning. It does not perform attest services: no audit, no review, no compilation. If a lender or a landlord has asked you for an audited or reviewed financial statement, that is a different engagement at a different firm, and we will say so rather than stretch to fit it.
Books and the return are two different jobs. bookkeepz, LLC, an affiliated company, keeps monthly books for nurse practitioners and other private practices, and its bookkeeping page for nurse practitioners covers that side. bookkeepz is not a CPA firm and does not do tax work. Most clients who need both use both, under separate engagements.
Questions
What nurse practitioners ask
Is my collaborative physician fee deductible?
Generally yes, as an ordinary and necessary business expense, provided the arrangement is documented and the payments reflect it. The exposure is usually in the documentation rather than in the deduction itself.I am licensed in several states for telehealth. Do I file in all of them?
Not necessarily all, but potentially several, and it depends on where patients actually are rather than where you hold a license. This is worth mapping during the year.I want to add aesthetics. What changes?
You acquire inventory, and possibly a sales tax obligation, and part of your revenue may sit outside the clinical service field for QBI purposes. It is worth structuring at the point you add it.Do you also do my bookkeeping?
No. This firm prepares returns and does planning. bookkeepz, LLC, an affiliated company, keeps the monthly books and is not a CPA firm.Talk to a CPA who has seen this practice before
Thirty minutes, no charge. Bring last year’s return and the thing you were not sure about.