Nurse practitioner (NP) specializations are defined by the Advanced Practice Registered Nurse Consensus Model or statute in each state, and these specialties are certified through national organizations. Clinical subspecialties are determined by subspecialty organizations like the Dermatology Nurses' Association (DNA) and are of increasing importance to NPs as our practices become more specialized. The availability of and process for certification varies widely among subspecialties, and some, including dermatology, have clinical practice requirements. However, with statutory restrictions on NP practice in a majority of states, the settings where practice hours can be obtained can be limited, leading to practical restrictions that mean some specialized NPs, such as dermatology, cannot achieve certification