Latitude Life Insurance
Latitude Life Insurance
Your assigned ACA Agent is Mr. Dennis White. Dennis is a certified ACA Agent and specializes in helping Florida residents obtain healthcare though the federal marketplace, commonly referred to as Obamacare. Dennis’ National Producer Number (NPN) is 18897149.
This self-enrollment service works for individuals and families that may qualify for completely FREE coverage. If based on your entries below it’s determined that you qualify for less than 100 percent government-assisted coverage, Dennis will contact you to discuss your options prior to enrollment.

Gender
Name
DOB
SSN
Phone
Email
Address
Zip code
County

Do you smoke or use any tobacco products?

Do you require specific doctors to be in-network for offered coverage?

Enter medications you take - this is needed to select the best provider that covers these medications.

Do you grant permission for your assigned agent, Mr. Dennis White, to become your agent of record as it relates to Obamacare/ACA and to have Mr. Dennis White enroll you into suitable FREE healthcare coverage?
Type your initials below to confirm your permission:

If for any reason you do not qualify for FREE coverage, Dennis will contact you to discuss your options.

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