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Details for CLARK, KELLY WILLIAM

Agent Details
Name
CLARK, KELLY WILLIAM 
Address
4109 HEADSAIL DR NEW PORT RICHEY, FL 34652-4463 
Business Phone
(813) 263-8435 
Internet
 
Email
k.clark@e-telequote.com  
Status
Active 
Issue Date
Oct 10, 2012 
License Status Expires Number
Non-Resident Producer Active Jan 31, 2023 427119
      Accident and Hlth or Sickness Active Issued: Aug 09, 2018
      Life Active Issued: Oct 10, 2012
      Accident & Health Inactive Issued: Oct 10, 2012
Agency Affiliations City State License Number Active Date Status
HEALTH PLAN INTERMEDIARIES HOLDINGS LLC TAMPA FL 514705 Dec 17, 2019 Active
HEALTH PLAN INTERMEDIARIES HOLDINGS LLC TAMPA FL 418652 Dec 17, 2019 Active
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