Credentialing Portal

Please complete each section to begin the credentialing process. You can upload your required documents and share your shift availability. Your information is sent securely to the Nursiva team for review.

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Profile details

Provide your basic contact information so we can match your documents and availability.

First name*

Last name*

Email address*

Use the email you want to receive shift and onboarding information.

Mobile phone*

Primary role / discipline*

Identity documentation

Upload clear photos or scans of the required identity documents.

Social Security card*

Please ensure your full name and SSN are clearly legible.

Government ID – front*

Government ID – back*

Active license

Provide your current CNA/LPN/RN license details and proof.

License type*

State of license*

License number*

License expiration date*

Upload license (screenshot or PDF)*

Health documentation

Upload your TB test and flu/covid vaccine or declination forms.

TB test (within last 12 months)*

Upload full results or provider documentation.

Date of most recent TB test*

Flu vaccine or declination*

Covid vaccine or declination*

CPR / BLS / ACLS (if applicable)

Upload any current life support certifications you hold.

Which certifications do you hold?

Upload CPR/BLS card

Upload ACLS card (if applicable)

If you do not currently hold these certifications, you can leave this section blank.

Weekly availability for shifts

Check all boxes that match when you are generally available to pick up shifts.

Day	AM	PM	Night
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

You can update your availability with Nursiva at any time by contacting the office.

Nursiva

Louisville, Ky