DEPARTMENT OF INSURANCE

Name	Lake, Tamara	DOIID	928234	NAIC NPN	18058629

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Active	Non Resident	Agent	Health	9/9/2016		12/31/2026

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

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	10/15/2024	12/31/2024	11/04/2024	11/04/2024	Yes

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	Optum 4 Walnut Grove DrHorsham, PA 190442201
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(610) 295-0537