black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

TRACY PETTAPIECE FUNK

PRODUCER NON-RESIDENT

License Number:
PRN373667
Status:
Active
First Licensure:
01/27/2021
Cancel Date:
None

Mailing:
ROSWELL, GA 30075
Phone:
+1 (678) 384-4628
Fax:
+1 (770) 777-2644
Email:
blinsurance@cscglobal.com

History
License Type Start Date End Date
PRODUCER NON-RESIDENT 01/27/2021

Agency
Name Issue Date License Number Expiration Date Cancel Date
HODGES-MACE LLC
 01/27/2021 AGN111803 11/29/2022

Employer
Name Issue Date License Number Expiration Date Cancel Date
ACE AMERICAN INSURANCE COMPANY
 03/28/2022 PCF640 06/27/2023
ACE PROPERTY & CASUALTY INSURANCE COMPANY
 03/10/2022 PCF44 06/27/2023
COMBINED INSURANCE COMPANY OF AMERICA
 03/07/2022 LHF144

Authority
Description Issue Date Termination Date Status
HEALTH 01/27/2021 Active
LIFE 01/27/2021 Active

License/Disciplinary Action

None.

PRODUCER RESIDENT

License Number:
PRR41330
Status:
Withdrawn/Terminated by Licensee
First Licensure:
01/30/1995
Cancel Date:
07/27/2004
Renewal Date:
07/27/2004

Mailing:
ROSWELL, GA 30075
Phone:
+1 (678) 384-4628
Fax:
+1 (770) 777-2644
Email:
blinsurance@cscglobal.com

History
License Type Start Date End Date
PRODUCER RESIDENT 01/30/1995 07/26/2004

Agency
Name Issue Date License Number Expiration Date Cancel Date
EBM INC
 10/24/2001 AGR81588 07/27/2004
EMPLOYEE BENEFIT MANAGEMENT INC
 06/07/2000 AGR48635 10/24/2001

Employer
Name Issue Date License Number Expiration Date Cancel Date
AMERICAN BANKERS LIFE ASSURANCE COMPANY OF FLORIDA
 07/07/1997 LHF115 07/27/2004
AMERICAN HERITAGE LIFE INSURANCE COMPANY
 04/17/1998 LHF594 07/27/2004
AMERICAN INTERNATIONAL LIFE ASSURANCE COMPANY OF NEW YORK
 06/14/2001 LHF122 07/27/2004
BOSTON MUTUAL LIFE INSURANCE COMPANY
 05/21/1997 LHF135 07/27/2004
CENTRAL STATES HEALTH & LIFE COMPANY OF OMAHA
 02/05/2003 LHF959 07/27/2004
CONCORD HERITAGE LIFE INSURANCE COMPANY INC
 05/12/1997 LHF146 07/27/2004
CONTINENTAL CASUALTY COMPANY
 03/07/2003 PCF420 07/27/2004
FIRST COLONY LIFE INSURANCE COMPANY
 11/06/1997 LHF175 11/11/2003
MEDICAL LIFE INSURANCE COMPANY
 10/01/2002 LHF1016 07/27/2004
NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA
 01/11/2002 PCF527 07/27/2004
PROVIDENT LIFE & ACCIDENT INSURANCE COMPANY
 05/24/1999 LHF250 07/27/2004
TRANSAMERICA ASSURANCE COMPANY
 06/02/2003 LHF956 07/27/2004
TRANSAMERICA LIFE INSURANCE COMPANY
 07/22/2004 LHF726 07/27/2004
UNUM LIFE INSURANCE COMPANY OF AMERICA
 09/08/1997 LHD145 07/27/2004

Authority
Description Issue Date Termination Date Status
LIFE AND HEALTH 01/30/1995 07/27/2004 Terminated

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
1923235

Other Addresses
Address Type
5775 GLENRIDGE DR # D
ATLANTA, GA 30328-5380
 Office

An active license/permit may still be subject to limitations and restrictions as a result of disciplinary action imposed. Please contact the specific licensing board about specific disciplinary actions.

Date: 07/04/2026 06:38:06 PM