Thank you for your interest in requesting privileges at Florence Community Healthcare!
Please select one of the following Applications to apply for Florence Community Healthcare medical staff or allied health privileges, print and return to P.O. Box 1589, Florence, Arizona, 85132.
As the applicant you will be responsible to provide complete information and answers to the questions with explanation on a separate sheet of paper as indicated and requested; then return the application to the Medical Staff Office.
Copies of the following documents must accompany your application regardless of category:
- Current Arizona license
- Face sheet of your current professional liability insurance noting limits, expiration date and coverage
- DEA certificate (if applicable)
- Medical school diploma
- Certificates from internship, residency and fellowship programs
- Specialty board certificate(s)
- Clear copy of a government issued photo ID
Please be aware that while every effort is made to expedite the process, completion of your application can take from 60-90 days, depending on the response time from other organizations and your peer references. To ensure that your application is processed timely, submit a complete application with all available contact information for references and professional affiliations. Supplemental documentation and revised information may also be submitted via confidential fax at (888)607-6765
To obtain information regarding physician licensing in Arizona, you can contact the Arizona Medical Board at:
9545 E. Doubletree Ranch Road
Scottsdale, Arizona 85258-5539
Toll Free: 877 255-2212
Website:
www.azmd.gov
If you have any questions regarding the credentialing process, you can contact Human Resources at (520)494-3210.
