DEPARTMENT OF INSURANCE

Name	Health Source One Insurance Group, LLC	DOIID	787497	NAIC NPN	16735053

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Inactive	Non Resident	Agent	Health	9/21/2012	3/31/2016
Inactive	Non Resident	Agent	Life	9/21/2012	3/31/2016

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

No License Renewal Information

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date.

Address Information

Type	Address
Business / Home Office	1515 S Federal Hwy Boca Raton, FL 33432

Phone Information

Type	Phone
Business / Home Office	(214) 871-2118