Background: Mobile Stroke Units (MSU) are growing worldwide, with numerous staffing configurations, including telemedicine support. We aimed to test a novel nurse practitioner (NP) MSU team. Methods: We hired stroke fellowship trained NPs with ANVP board certification to lead MSU field medical diagnosis and order/initiate treatment. Consecutive patients were evaluated; NP and Vascular Neurologist (VN) differences were assessed between diagnostic accuracy and IVtPA decisions. Safety was measured by sICH. Efficiency measures were time to treatment.