483.302  Application for license.--

(1)  Application for a license as required by s. 483.30 must be made to the agency on forms furnished by it and must be accompanied by the appropriate license fee.

(2)  The application shall contain:

(a)  A determination as to whether the facility will be fixed or mobile and the location for a fixed facility.

(b)  The name and address of the owner if an individual; if the owner is a firm, partnership, or association, the name and address of every member thereof; if the owner is a corporation, its name and address and the name and address of its medical director and officers and of each person having at least a 10 percent interest in the corporation.

(c)  The name of any person whose name is required on the application under the provisions of paragraph (b) and who owns at least a 10 percent interest in any professional service, firm, association, partnership, or corporation providing goods, leases, or services to the center for which the application is made, and the name and address of the professional service, firm, association, partnership, or corporation in which such interest is held.

(d)  The name by which the facility is to be known.

(e)  The name, address, and Florida physician's license number of the medical director.