Opening a VAT number as a freelance nurse is an increasingly popular choice.

Many nurses decide to work independently in nursing homes, private clinics, home care, or with cooperatives.

In this guide updated to 2026 you will find:

- What is the correct ATECO code?

- How much tax do you pay in the flat-rate scheme?

- How much do you pay to ENPAPI?

- How much does it cost to open a VAT number?

- When it really pays off

A nurse can open a VAT number:

- registered with ENPAPI

- registered with the Order of Nursing Professions (OPI)

- who carries out activities independently and continuously

You can work in:

- RSA

- Private clinics

- Home care

- Affiliated structures

- Collaborations with medical practices

The new ATECO code specifically for freelance nurses in Italy is 86.94.01 - "Nursing Activities," which replaced the previous code 86.99.09 (Other Independent Paramedic Activities).

Most nurses choose the flat-rate scheme because:

- 5% substitute tax for the first 5 years (if you qualify)

- Then 15%

- No VAT

- Simplified accounting

Practical example:

I will invoice €30,000:

30,000 × 78% = €23,400 taxable income

On this you pay:

- ENPAPI Contributions

- Substitute tax 5% or 15%

Self-employed nurses must register with ENPAPI (National Institute for Social Security and Welfare of the Nursing Profession).

The main contributions are:

- Subjective contribution (percentage of income)

- Additional contribution (4% on the invoice)

- Maternity contribution (fixed amount)

Opening a VAT number:

- Opening hours: free (online)

- ENPAPI registration: mandatory

- Possible consultant costs

- Delivery time: 1-3 business days

Main annual costs:

- Social security contributions

- Substitute tax

- Consultant's fee

Simplified real-world example:

Turnover: €40,000

Taxable income (78%): €31,200

After contributions tax:

Estimated net: approximately €26,000–28,000

Obviously it varies depending on your personal situation.

It is advisable to leave your job if:

- You have more collaboration requests

- You can work on multiple structures

- Do you want to increase your earnings?

- You are looking for flexibility

It is not convenient if:

- You have no job continuity

- You don't have any customers yet

Mistakes to avoid:

- Choosing the wrong ATECO code

- Not registering correctly with ENPAPI

- Not evaluating the tax regime well

- Don't plan minimum contributions

If you want to work as a freelance Social Health Worker (OSS), this guide will help you learn how to open a VAT number, how much it costs, and how much tax and social security contributions you'll need to pay.

To open a VAT number, you must send form AA9/12 to the Revenue Agency.

In the form you will need to indicate:

- Your personal data

- The chosen tax regime (flat rate or ordinary)

- Your business's ATECO code

For the Healthcare Assistant, the most commonly used ATECO code is:

88.10.00 – Non-residential social care for the elderly and disabled

(The classification may vary based on the type of activity performed.)

You can submit the form:

- Online

- By registered mail

- By hand delivering it to a local office.

Opening an account is free. You only pay if you use an accountant.

Unlike nurses, OSSs do not have their own social security fund. Generally, VAT-registered social health workers must register with:

INPS – Separate Management

The rate for professionals without a fund varies from year to year (around 26%).

Contributions are calculated on:

- 78% of your earnings if you are in the flat-rate scheme

- Income (earnings minus expenses) if you are in ordinary employment

Unlike other INPS schemes, there is no fixed minimum contribution: you pay only based on your earnings.

In addition to INPS contributions, you must pay taxes.

With the flat-rate scheme:

- 5% for the first 5 years (if you qualify)

- 15% thereafter

Taxes are calculated on 78% of earnings, net of contributions paid.

Ordinary Regime

- IRPEF from 23% to 43%

- Regional and municipal surcharges

- VAT and additional accounting requirements

The flat-rate regime is convenient if:

- invoices less than €85,000 per year

- you have few expenses to deduct

- you want simple management

In many cases, it is the most advantageous regime for those who work as self-employed OSS.

Each OSS has a different situation:

- Do you also have a job?

- Do you work with cooperatives or private individuals?

- Do you foresee any major expenses?

- Can you access the 5%?

With a personalized simulation you can know:

- How much will you pay in contributions?

- How many cups will I pour?

- Which regime is best for you?

- How much do you have left over?

Opening and managing a VAT number as a dentist means meeting specific tax, social security, and administrative obligations.

To practice the profession of dentist it is necessary:

- registration with the Order of Surgeons and Dentists,

- opening of VAT number (ATECO code 86.23.00 – Dental practice activities),

- registration with the ENPAM pension fund.

If you opt for the flat-rate scheme, the substitute tax will be:

- 5% for the first 5 years (start-up),

- 15% from the sixth year,

- no VAT on the invoice,

- no withholding tax.

Income is calculated by applying a profitability coefficient (78% for professional activities).

The advantages:

- simplified taxation,

- fewer formalities,

- ideal for young dentists or starting out.

If you opt for the Ordinary Regime:

- IRPEF in brackets (23%–43%),

- regional and municipal surcharges,

- deduction of actual costs,

- accounting records and VAT compliance.

The advantages:

- possibility of fully deducting expenses,

- more convenient in the presence of high costs (studio, equipment, personnel).

Dentists pay contributions to EMPAM

- Quota A: mandatory fixed amount,

- Quota B: percentage of freelance income.