New CredAxis Provider Group
Elizabeth Duffin (Collins), Credentialing & Project
Manager, email@example.com Matt Romeo, Project Manager,
firstname.lastname@example.org,Sherry zamot cred.cordinator email@example.com
New Provider Group Information
Welcome to the CredAxis Family!
Please complete the paperwork attached to get your credentialing process started . Please be sure to sign all
paperwork in BLUE INK (DO NOT DATE ANY DOCUMENTS) at area denoted by a *. This is indicative of the required originals
when we forward paperwork for processing . Please do not skip any portions of the attached provider group information
Kindly return copies of your group New Practice Checklist Documents (We do not need the originals) with your signed
paperwork. Any missing or incomplete information will delay the credentialing process.
Please contact us if you have any questions.
Elizabeth Duffin (Collins) Credentialing Manager
Matt Romeo Project Manager
Attention: Credentialing Department 1214 Mariner BlvdSpring
Hill, FL 34609-5657
Please download the Insurance Authorization form by clicking download button below and complete the PDF file attached and
upload it by clicking upload button below to
get your credentialing process started. Please be sure to digital sign PDF file attached.