Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Lacey Elissa Rose, PA

Individual provider Surgical Physician Assistant · NPI 1629839709

Mrs. Lacey Elissa Rose, PA is a Physician Assistant in Sarasota, Florida. Qualified in 2024, 2 years ago. Practices with Smh Physician Services Inc, a 774-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Florida and New York.

Years since qualifying
2
Licensed in
FL, NY
In the registry since
2024
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1700 S Tamiami Trl
Sarasota, FL 34239-3509
Phone: (941) 917-7494
Fax: (941) 917-7739
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 301 E Main St, Bay Shore, NY 11706-8408 — (631) 968-3000

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PA9120077 (FL)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence 031360 (NY)

Record details

NPI number1629839709
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJanuary 17, 2024
Last updated in NPPESAugust 7, 2026
Certification dateAugust 7, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Smh Physician Services Inc — 774 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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