DEPARTMENT OF INSURANCE

Affiliations

Name	Burgess, Tara Phoenix	DOIID	919112	NAIC NPN	17777101

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	6/22/2016	6/30/2018
Inactive	Non Resident	Agent	Life	6/22/2016	6/30/2018
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	7/29/2016	6/9/2017
Inactive	Aetna Life Insurance Company	301140	Agent - Health	7/29/2016	6/9/2017
Inactive	Aetna Life Insurance Company	301140	Agent - Life	10/1/2016	6/9/2017
Inactive	American Retirement Life Insurance Company	706303	Agent - Health	11/21/2016	6/30/2018
Inactive	American Retirement Life Insurance Company	706303	Agent - Life	11/21/2016	6/30/2018
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	7/13/2016	5/26/2017
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	7/29/2016	6/9/2017
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	7/13/2016	5/26/2017
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	7/13/2016	5/26/2017
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	7/13/2016	5/26/2017
Inactive	Humana Insurance Company	301104	Agent - Health	7/13/2016	5/26/2017
Inactive	Humana Insurance Company	301104	Agent - Life	7/13/2016	5/26/2017
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	7/13/2016	5/26/2017
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	7/13/2016	5/26/2017
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	7/13/2016	5/26/2017
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	10/12/2016	5/26/2017
Inactive	SilverScript Insurance Company	663526	Agent - Health	7/28/2016	6/30/2018
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	8/5/2016	4/26/2017
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	9/16/2016	4/26/2017
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	8/5/2016	12/5/2016
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	8/5/2016	4/26/2017

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	eHealthInsurance Services Inc.	514105	Agent - Life	8/31/2016	3/8/2018
Inactive	eHealthInsurance Services Inc.	514105	Agent - Health	8/31/2016	3/8/2018