DH 4147, 8/12 64E-28.003, F.A.C.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
Authority 381.00775, Florida Statutes
Application for Tattoo Artist License
Instructions: Do not leave any item blank. Enter “NA” for non-applicable items. For initial license and license renewal, submit
the completed application to the county health department that has jurisdiction for the tattooing program in the county where the
applicant lives. To select the county, type the following link into Internet browser:
http://www.myfloridaeh.com/community/biomedical/county_coordinators.htm. This application must be accompanied by the
following:
Fee of $60.00 (submit every year).
Reactivation fee of $25.00 for renewal of license after date of expiration.
A copy of a government-issued photo identification confirming at least 18 years of age (submit for initial registration
only, not renewal).
A copy of the certificate of training proving completion of a department approved course on blood-borne pathogens and
communicable diseases with having achieved a minimum score of at least 70% on the course examination (submit for
initial application only, not renewal).
DH use only: Check No. Check Amount
Date Received Receipt No.
Facility Permit No. Date Issued
Amended Application Only Date Received
Type of License: ____ Initial ____ Renewal
Name of Applicant: ______________________________________________________________________________
Physical Address of Applicant: ______________________________________________________________________
Street City State Zip Code
Mailing Address if Different: ________________________________________________________________________
P.O. Box or Street City State Zip Code
Phone Number: _(____)__________________ E-mail Address: _____________________________@___________________
Provide the following information for each tattoo establishment or temporary tattoo establishment where the applicant will perform
tattooing or intends to perform tattooing:
1. ___________________________________________________________________________________________
Name of Licensed Establishment Department of Health License Number
2. ___________________________________________________________________________________________
Name of Licensed Establishment Department of Health License Number
3. ___________________________________________________________________________________________
Name of Licensed Establishment Department of Health License Number
The undersigned Applicant hereby agrees to practice tattooing in compliance with ss. 381.00771-381.00791, F.S., and Chapter
64E-28, F.A.C., and exclusively at an establishment licensed under ss. 381.00771-381.00791, F.S., and
Chapter 64E-28, F.A.C. The information contained in this application, which serves as a basis for licensure, is true and correct. I
understand that any misrepresentation of the facts in this application, or failure to comply with sanitary standards, is grounds for
denial, administrative fine and/ or revocation of the tattoo license. Further, I understand that obtaining or attempting to obtain a
license or registration by means of fraud, misrepresentation, or concealment is committing a misdemeanor of the second degree
punishable as provided in s. 775.082 or s. 775.083.
_______________________________________________________ ___________________________
Name of Applicant (print or type) Date
_______________________________________________________
Signature of Applicant
Alachua
Department of Health in Alachua,
Environmental Health Section
224 SE 24th Street, Gainesville,
FL 32601
(352) 334-7930
Baker
See Duval
Bay
Department of Health in Bay
County, Environmental Health
Section
597 West 11th Street, Panama
City, FL 32401
(850) 872-4660
Bradford
See Alachua
Brevard
Department of Health in Brevard
County, Environmental Health
Section
Government Center
2725 Judge Fran Jamison Way,
Building A 116, Viera, FL 32940
(321) 633-2100
Broward
Department of Health in Broward
County, Environmental Health
Section
2421 SW 6th Avenue, Fort
Lauderdale, FL 33315
(954) 467-4700
Calhoun
Department of Health in Calhoun
County, Environmental Health
Section
19611 State Road 20 West,
Blountstown, FL 32424
(850) 674-5645
Charlotte
Department of Health in Charlotte
County, Environmental Health
Section
18500 Murdock Circle, Suite 203,
Port Charlotte, FL 33948
(941) 743-1266
Citrus
See Marion
Clay
Department of Health in Clay
County, Environmental Health
Section
P.O. Box 578, Green Cove
Springs, FL 32043
(904) 278-3782
Collier
Department of Health in Collier
County, Environmental Health
Section
3339 E. Tamiami Trail, Suite 145,
Naples, FL 34112
(239) 252-8200
Columbia
See Alachua
Dade (Miami-Dade)
Department of Health in Miami-
Dade County, Environmental
Health Section
1725 NW 167th Street, Miami
Gardens, FL 33056
(305) 623-3500
DeSoto
Department of Health in DeSoto
County, Environmental Health
Section
34 S. Baldwin Avenue, Arcadia, FL
34266
(863) 993-4601
Dixie
See Alachua
Duval
Duval provides service for: Baker
& St. Johns County
Department of Health in Duval
County, Environmental Health
Section
900 University Boulevard N., Suite
300, Jacksonville, FL 32211
(904) 253-1785
Escambia
Escambia provides service for:
Okaloosa, Santa Rosa, and
Walton County
Department of Health in Escambia
County, Environmental Health
Section
1300 West Gregory, Pensacola,
FL 32501
(850) 595-6700, ext. 2052
Flagler
Department of Health in Flagler
County, Environmental Health
Section
P.O. Box 847, Bunnell, FL 32110
(386) 437-7358
Franklin
Department of Health in Franklin
County, Environmental Health
Section
137 12th Street, Apalachicola, FL
32329
(850) 653-2113
Gadsden
Department of Health in Gadsden
County, Environmental Health
Section
Physical Address: 278 LaSalle
Lefall Drive, Quincy, FL 32353
Mailing Address: P.O. Box 1000,
Quincy, FL 32353
(850) 875-7200
Gilchrist
See Alachua
Glades
Department of Health in Glades
County, Environmental Health
Section
1021 Health Park Drive, Moore
Haven, FL 33471
(863) 946-0707, ext. 203
Gulf
Department of Health in Gulf
County, Environmental Health
Section
2475 Garrison Avenue, Port St.
Joe, FL 32456
(850) 227-1276, ext. 125
Hamilton
See Alachua
Hardee
See Polk
Hendry
Department of Health in Hendry
County, Environmental Health
Section
1140 Pratt Boulevard, LaBelle, FL
33975
(863) 674-4047
Hernando
Department of Health in Hernando
County, Environmental Health
Section
7551 Forests Oaks Boulevard,
Spring Hill, FL 34606
(352) 540-6800
Highlands
Department of Health in Highlands
County, Environmental Health
Section
Mailing Address: 7205 South
George Boulevard, Sebring, FL
33875
Physical Address: 501 South
Commerce Avenue, Sebring, FL
33870
(863) 402-6550
Hillsborough
Department of Health in
Hillsborough County,
Environmental Health Section
P.O. Box 5135, Tampa, FL 33675-
5135
(813) 307-8015
Holmes
Department of Health in Holmes
County, Environmental Health
Section
603 Scenic Circle, Bonifay, FL
32425
(850) 547-8500
Indian River
Department of Health in Indian
River County, Environmental
Health Section
1900 27th Street, Vero Beach, FL
32960-3383
(772) 794-7440
Jackson
Department of Health in Jackson
County, Environmental Health
Section
4487 Lafayette Street; P.O. Box
310, Marianna, FL 32448
(850) 482-9227
Jefferson
Department of Health in Jefferson
County, Environmental Health
Section
1255 West Washington,
Monticello, FL 32344
(850) 342-0170
Lafayette
See Alachua
Lake
Department of Health in Lake
County, Environmental Health
Section
Physical Address: 315 W. Main
Street, Tavares, FL 32778
Mailing Address: P.O. Box 1305,
Tavares, FL 32778
(352) 253-6130
Lee
Lee provides service for Lee and
Charlotte County
Department of Health in Lee
County, Environmental Health
Section
2295 Victoria Avenue, Fort Myers,
FL 33901
Leon
Department of Health in Leon
County, Environmental Health
Section
435 N. Macomb Street,
Tallahassee, FL 32301
(850) 606-8350
Levy
See Alachua
Liberty
Department of Health in Liberty
County, Environmental Health
Section
12832 NW Central Avenue, Bristol,
FL 32321
(850) 643-2415
Madison
Department of Health in Madison
County, Environmental Health
Section
218 SW 3rd Avenue, Madison, FL
32340
(850) 973-5000
Manatee
Department of Health in Manatee
County, Environmental Health
Section
410 Sixth Avenue, E., Bradenton,
FL 34208
(941) 748-0747
Marion
Department of Health in Marion
County, Environmental Health
Section
1801 SE 32nd Avenue, Ocala, FL
34478
(352) 622-7744
Martin
Department of Health in Martin
County, Environmental Health
Section
3441 SE Willoughby Boulevard,
Stuart, FL 34994
(772) 221-4090
Monroe
Department of Health in Monroe
County, Environmental Health
Section
102050 Overseas Highway, Suite
202, Key Largo, FL 33037
(305) 289-2721
Nassau
Department of Health in Nassau
County, Environmental Health
Section
P.O. Box 15100, Fernandina
Beach, FL 32035
(904) 530-6800
Okaloosa
See Escambia
Okeechobee
Department of Health in
Okeechobee County,
Environmental Health Section
1728 NW 9th Avenue,
Okeechobee, FL 34972
Orange
Department of Health in Orange
County, Environmental Health
Section
1001 Executive Center Drive, Suite
200, Orlando, FL 32803
(407) 858-1497
Osceola
Department of Health in Osceola
County, Environmental Health
Section
1 Courthouse Square, Suite 1200,
Kissimmee, FL 34741
(407) 742-8600
Palm Beach
Department of Health in Palm
Beach County, Environmental
Health Section
Physical Address: 800 Clematis
Street, West Palm Beach, FL
33401
Mailing Address: P.O. Box 29,
West Palm Beach, FL 33401
(561) 837-5900
Pasco
Department of Health in Pasco
County, Environmental Health
Section
5640 Main Street, New Port
Richey, FL 34652
(727) 841- 4425
Pinellas
Department of Health in Pinellas
County, Environmental Health
Section
8751 Ulmerton Road, Suite 2000,
Largo, FL 33771
(727) 507-4336
Polk
Polk County provides services for:
Hardee County
Department of Health in Polk
County, Environmental Health
Section
2090 E. Clower Street, Bartow, FL
33830
(863) 519-8330, ext. 6
Putnam
See Alachua
Santa Rosa
See Escambia
Sarasota
Department of Health in Sarasota
County, Environmental Health
Section
1001 Sarasota Center Boulevard,
Sarasota, FL 34240
(941) 861-6133
St. Johns
See Duval
St. Lucie
Department of Health in St. Lucie
County, Environmental Health
Section
5150 NW Milner Drive, Port St.
Lucie, FL 34983
(772) 873- 4898
Seminole
Department of Health in Seminole
County, Environmental Health
Section
Physical Address: 1101 E. 1st
Street, Sanford, FL 32771
Mailing Address: 400 W. Airport
Boulevard, Sanford, FL 32773
(407) 665-3604
Sumter
Department of Health in Sumter
County, Environmental Health
Section
415 East Noble Avenue, Bushnell,
FL 33513
(352) 569-3131
Suwannee
See Alachua
Taylor
Department of Health in Taylor
County, Environmental Health
Section
1215 N. Peacock Avenue, Perry,
FL 32347
(850) 584-5087, ext. 157
Union
See Alachua
Volusia
Department of Health in Volusia
County, Environmental Health
Section
1845 Holsonback Drive, Daytona
Beach, FL 32117
(386) 822-6244
Wakulla
Department of Health in Wakulla
County, Environmental Health
Section
48 Oak Street, Crawfordville, FL
32327
(850) 888-6099
Walton
See Escambia
Washington
Department of Health in
Washington County,
Environmental Health Section
1338 S. Boulevard, Chipley, FL
32428
(850) 638-6240
