Renew with HNA

Doctor's First Name:

Doctor's Last Name:

Email Address:

Address:

City:

State:

Zip Code:

Phone:

Fax:

Federal Tax ID Number:

NPI Number:

Malpractice Insurance Carrier

Name:

Expiration Date:

State License

Number:

Expiration Date:

DEA Certificate (Does not apply to D.C.)

Specialty:

Number:

Expiration Date:

Your Initials:

By checking this box and entering my initials, I represent that I have read and understand the Terms and Conditions of my membership. I further represent that all of the information submitted on the above enrollment form is correct to the best of my knowledge.

Verification:

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To Renew your Credentialing Offline

Follow these steps:

Step 1:

Complete the one page downloadable Renewal Form, and submit with membership fees. You may FAX it to 602-485-3100 or mail in the forms. If you are a facility, download the Facility Renewal Form.

Step 2:

A confirmation will be sent to you upon completion.

Valued HNA Member:

Our goal is to bring you programs to make your practice a more profitable practice - to get more patients, lower overhead and better practice efficiency.

HNA has added additional patient contracts bringing the total to 6,800 payers
HNA providers currently service over 24 million patients.
HNA instituted a vendor program to offer discounts on practice expenses
HNA created an information and education email system to inform you on critical practice issues
HNA has NO automated phone system. You Call - We Answer! Making out systems more provider friendly.
Save time and save a stamp by renewing your membership electronically.

Download the one page Renewal Form, complete the form and FAX it back to 602-485-3100 or mail in the renwal to P.O. BOX 71717, Phoenix, AZ 85050

877-315-3338

Renew with HNA

Renew with HNA

Malpractice Insurance Carrier

State License

DEA Certificate (Does not apply to D.C.)

To Renew your Credentialing Offline

Valued HNA Member: