(1) The telemedicine license issued by the board shall contain the name of the person to whom it is issued, the address of the person, the date and number of the license and such other information as the board deems necessary. The address contained on the telemedicine license shall be the address of the licensee where all correspondence and renewal forms from the board shall be sent during the two years for which the license has been issued and shall be the address deemed sufficient for purposes of service of process.