Provider Demographics
NPI:1629839709
Name:ROSE-CRACCHIOLO, LACEY ELISSA (PA)
Entity type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:ELISSA
Last Name:ROSE-CRACCHIOLO
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 947407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1700 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3509
Practice Address - Country:US
Practice Address - Phone:941-917-7494
Practice Address - Fax:941-917-7739
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2025-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY363AS0400X
FLPA9120077363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical