Requesting an application for Allied Staff membership

Please contact the Medical Staff Office to request an application, referred to as a “Request for Consideration – RFC” for staff membership and clinical privileges for your specific specialty. Gabrielle Pepperman at (850) 747-7109 or via email.

Step 1

You will need to call or email Gabrielle Pepperman in order to start the credentialing process. She will then send a pre application to get some basic knowledge such as full legal name, social security number, and NPI number. When you return the pre application to Gabrielle Pepperman by fax, email, or in person she will submit this and you should receive the online application through your email within 48 hours. The application fee can be paid by check, please see more about application fees in the Frequently Asked Questions section. Application that do not include the application fee will not be processed until the fee has been received.

Step 2

Once you have received your application packet, read the Medical Staff Bylaws, HCA Code of Conduct, Mission, Vision and Values Statement. All applicants should thoroughly review these documents prior to requesting staff membership and/or clinical privileges. You will be asked to sign an attestation that you have read and fully understand and agree to comply with the Medical Staff Bylaws, Rules and Regulations, and applicable policies.

Step 3

Once you have fully completed the Request for Consideration, please submit the application online. This will send the paperwork directly to the Parallon Credentialing Processing Center in Jacksonville, Florida. Please send any supplemental documents to Gabrielle Pepperman in the Medical Staff Office. Also keep a copy for your records.

By accepting and completing a Request for Consideration and returning it with the $75 dollar application fee, you acknowledged that you have reviewed and understand the Medical Staff Bylaws, Rules and Regulations, and Code of Conduct. You further agree to be bound by the same, both at the time of application and throughout your appointment and reappointment terms. You are strongly urged to print these documents for future reference and be familiar with them.

Credentialing Portal